Billing code
J895C — Level 1 sleep study – therapeutic
Therapeutic overnight sleep study
Bill J895 for an overnight Level 1 therapeutic sleep study, such as CPAP or BiPAP titration, after a sleep physician's assessment.
Watch for: One per patient in any two consecutive 12-month periods without prior approval, and not in the same 12 hours as J896 or J897.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $0.00 | $0.00 | $430.55 | $97.50 | $97.50 |
- Code
- J895C
- Description
- Level 1 sleep study – therapeutic
- FHO+ basket
- Not in the FHO+ base rate basket (Schedule 2 or 2B).
- Effective date
- Apr 1, 2026
- Termination date
- No end date
Explanation
Updated October 26, 2026
Overnight Level 1 therapeutic sleep study, for example CPAP/BiPAP titration or checking the response to OSA treatment.
What it covers
A therapeutic study is done after a pre-study assessment by a sleep physician to set positive airway pressure and/or oxygen for sleep-related breathing disorders, evaluate surgery, oral appliance, positional therapy or major weight loss for OSA, or titrate ventilation for respiratory control, neuromuscular or neurodegenerative disease (J111).
Examples of sleep-related breathing disorders are obstructive or central sleep apnea, Cheyne-Stokes breathing, complex sleep apnea and hypoventilation syndromes (J111).
Billing rules
- One therapeutic study per patient in any two consecutive 12-month periods, unless prior approval is given (J112).
- Not payable in the same 12-hour period as J896 or J897 (J112).
- Needs a pre-study assessment by a sleep physician, except when it immediately follows a diagnostic study the sleep physician has already planned, or in exceptional cases under an approved protocol or medical directive (J112).
- Studies for other reasons or over the limits need prior approval (J112).
- Bill the technical component (H) with suffix B and the professional component (P) with suffix C, as separate claims (J107).
- Outside a hospital or a hospital's off-site premises, only the professional component is payable (J107).
- The professional component requires an interpreting physician who meets the CPSO sleep medicine standards, and a qualified physician must be reachable throughout the study (J108).
- Special visit premiums are not payable with sleep studies (J108).
Common rejections
- ADH: OHIP's message is 'Cannot be billed together': J895 was billed in the same 12-hour period as J896 or J897 (J112).
Related codes: J896, J897, J898, J899, J990
Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Sleep Studies, page J112. Definition at J111; sleep study rules J107–J108.
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