CPT 95721
Global XXX ActiveEeg phy/qhp>36<60 hr w/o vid
CPT 95721 Billing & Documentation Guide
CPT code 95721 (Eeg phy/qhp>36<60 hr w/o vid) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.86, a non-facility practice expense RVU of 2.35, and a malpractice RVU of 0.33, a total non-facility RVU of 6.54 and facility RVU of 5.29. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $222.91, though rates vary from $202.03 to $283.06 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95721, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 95721 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 95721 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 95721
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.86 | 3.86 |
| Practice Expense RVU | 2.35 | 1.1 |
| Malpractice RVU | 0.33 | 0.33 |
| Total RVU | 6.54 | 5.29 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95721
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $232.4 | $183 | $223.05 - $262.2 | 29 |
| Florida | $229.14 | $187.25 | $220.53 - $238.51 | 3 |
| Georgia | $217.19 | $177.36 | $212.08 - $222.3 | 2 |
| Illinois | $226.29 | $185.94 | $217.82 - $234.01 | 4 |
| Michigan | $218.14 | $178.95 | $213.03 - $223.26 | 2 |
| North Carolina | $209.2 | $170.25 | $209.2 - $209.2 | 1 |
| New York | $237.59 | $191.01 | $211.24 - $250.97 | 5 |
| Ohio | $211.7 | $173.58 | $211.7 - $211.7 | 1 |
| Pennsylvania | $218.76 | $177.86 | $211.4 - $226.11 | 2 |
| Texas | $217.15 | $176.05 | $210.6 - $223.07 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 95721
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95721 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0733T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95717 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95718 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95719 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95720 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95812 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95813 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95816 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 95721
What does CPT code 95721 mean? +
CPT code 95721 represents: Eeg phy/qhp>36<60 hr w/o vid. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95721? +
The 2026 Medicare national average non-facility payment for CPT 95721 is $222.91. Rates range from $202.03 to $283.06 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95721? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 95721? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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