CPT 95801
Global XXX ActiveSlp stdy unatnd w/anal
CPT 95801 Billing & Documentation Guide
CPT code 95801 (Slp stdy unatnd w/anal) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.83, a non-facility practice expense RVU of 2.22, and a malpractice RVU of 0.06, a total non-facility RVU of 3.11 and facility RVU of 3.11. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $107.39, though rates vary from $92.45 to $138.77 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95801, 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 95801 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 95801 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 95801
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.83 | 0.83 |
| Practice Expense RVU | 2.22 | 2.22 |
| Malpractice RVU | 0.06 | 0.06 |
| Total RVU | 3.11 | 3.11 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95801
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 | $117.54 | $117.54 | $110.54 - $138.77 | 29 |
| Florida | $106.02 | $106.02 | $101.62 - $109.98 | 3 |
| Georgia | $100.9 | $100.9 | $96.25 - $105.55 | 2 |
| Illinois | $103.3 | $103.3 | $98.55 - $107.62 | 4 |
| Michigan | $100.17 | $100.17 | $97.68 - $102.66 | 2 |
| North Carolina | $98.19 | $98.19 | $98.19 - $98.19 | 1 |
| New York | $114.48 | $114.48 | $99.57 - $121.38 | 5 |
| Ohio | $97.44 | $97.44 | $97.44 - $97.44 | 1 |
| Pennsylvania | $102.75 | $102.75 | $97.69 - $107.8 | 2 |
| Texas | $102.74 | $102.74 | $97.06 - $108 | 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 95801
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95801 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0178T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0179T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0180T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0243T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0244T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0295T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0296T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0297T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0298T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0497T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 95801
What does CPT code 95801 mean? +
CPT code 95801 represents: Slp stdy unatnd w/anal. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95801? +
The 2026 Medicare national average non-facility payment for CPT 95801 is $107.39. Rates range from $92.45 to $138.77 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95801? +
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 95801? +
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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