CPT 95726
Global XXX ActiveEeg phy/qhp>84 hr w/veeg
CPT 95726 Billing & Documentation Guide
CPT code 95726 (Eeg phy/qhp>84 hr w/veeg) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 7.58, a non-facility practice expense RVU of 4.59, and a malpractice RVU of 0.6, a total non-facility RVU of 12.77 and facility RVU of 10.35. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $435.51, though rates vary from $395.19 to $554.09 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95726, 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 95726 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 95726 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 95726
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 7.58 | 7.58 |
| Practice Expense RVU | 4.59 | 2.17 |
| Malpractice RVU | 0.6 | 0.6 |
| Total RVU | 12.77 | 10.35 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95726
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 | $454.53 | $358.88 | $436.25 - $512.84 | 29 |
| Florida | $446.01 | $364.91 | $429.86 - $463.46 | 3 |
| Georgia | $423.79 | $346.69 | $413.82 - $433.77 | 2 |
| Illinois | $440.5 | $362.4 | $424.47 - $455.02 | 4 |
| Michigan | $425.35 | $349.45 | $415.78 - $434.91 | 2 |
| North Carolina | $409.02 | $333.61 | $409.02 - $409.02 | 1 |
| New York | $463.46 | $373.29 | $412.91 - $488.88 | 5 |
| Ohio | $413.35 | $339.55 | $413.35 - $413.35 | 1 |
| Pennsylvania | $427.05 | $347.88 | $412.86 - $441.24 | 2 |
| Texas | $424.12 | $344.54 | $411.31 - $435.02 | 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 95726
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95726 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 |
| 95721 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 95722 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 95723 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
Frequently Asked Questions, CPT 95726
What does CPT code 95726 mean? +
CPT code 95726 represents: Eeg phy/qhp>84 hr w/veeg. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95726? +
The 2026 Medicare national average non-facility payment for CPT 95726 is $435.51. Rates range from $395.19 to $554.09 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95726? +
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 95726? +
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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