CPT 95803: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT 95803 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT 95803 with a diagnosis that isn't covered typically denies as CARC 50 — not medically necessary.
National approximation. Coverage varies by MAC and state — confirm against the specific LCD/NCD and article that applies to your jurisdiction and date of service.
| ICD-10 | Description |
|---|---|
| F51.3 | Sleepwalking [somnambulism] |
| F51.4 | Sleep terrors [night terrors] |
| F51.5 | Nightmare disorder |
| G47.10 | Hypersomnia, unspecified |
| G47.11 | Idiopathic hypersomnia with long sleep time |
| G47.12 | Idiopathic hypersomnia without long sleep time |
| G47.13 | Recurrent hypersomnia |
| G47.14 | Hypersomnia due to medical condition |
| G47.19 | Other hypersomnia |
| G47.30 | Sleep apnea, unspecified |
| G47.31 | Primary central sleep apnea |
| G47.32 | High altitude periodic breathing |
| G47.33 | Obstructive sleep apnea (adult) (pediatric) |
| G47.34 | Idiopathic sleep related nonobstructive alveolar hypoventilation |
| G47.35 | Congenital central alveolar hypoventilation syndrome |
| G47.36 | Sleep related hypoventilation in conditions classified elsewhere |
| G47.37 | Central sleep apnea in conditions classified elsewhere |
| G47.39 | Other sleep apnea |
| G47.411 | Narcolepsy with cataplexy |
| G47.419 | Narcolepsy without cataplexy |
| G47.421 | Narcolepsy in conditions classified elsewhere with cataplexy |
| G47.429 | Narcolepsy in conditions classified elsewhere without cataplexy |
| G47.50 | Parasomnia, unspecified |
| G47.51 | Confusional arousals |
| G47.52 | REM sleep behavior disorder |
| G47.53 | Recurrent isolated sleep paralysis |
| G47.54 | Parasomnia in conditions classified elsewhere |
| G47.59 | Other parasomnia |
| G47.61 | Periodic limb movement disorder |
| G47.8 | Other sleep disorders |
| G47.9 | Sleep disorder, unspecified |
| R06.83 | Snoring |
| R09.02 | Hypoxemia |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT 95803?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 33 ICD-10 diagnosis codes that support medical necessity for CPT 95803. The covered codes are listed on this page. Coverage varies by MAC/state — always confirm against the policy that applies to you.
What is a medical-necessity (LCD/NCD) crosswalk?
A claim whose procedure isn't supported by a covered diagnosis denies as "not medically necessary" (CARC 50). CMS coverage policies define which diagnoses justify a procedure; this page is the ICD-10 → CPT 95803 view of that relationship.
More free billing tools: all crosswalks · NCCI edits · Medicare fees · denial codes
Informational only, not coding, billing, or legal advice. Based on CMS Medicare Coverage Database data; verify the current LCD/NCD for your MAC before billing.
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