CPT 95813
Global XXX ActiveEeg extnd mntr 61-119 min
CPT 95813 Billing & Documentation Guide
CPT code 95813 (Eeg extnd mntr 61-119 min) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.63, a non-facility practice expense RVU of 12.61, and a malpractice RVU of 0.12, a total non-facility RVU of 14.36 and facility RVU of 14.36. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $498.55, though rates vary from $418.31 to $669.93 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95813, 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 95813 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 95813 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 95813
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.63 | 1.63 |
| Practice Expense RVU | 12.61 | 12.61 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 14.36 | 14.36 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95813
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 | $556.95 | $556.95 | $519.14 - $669.93 | 29 |
| Florida | $484.83 | $484.83 | $463.12 - $503.03 | 3 |
| Georgia | $461.13 | $461.13 | $434.92 - $487.34 | 2 |
| Illinois | $469.26 | $469.26 | $445.25 - $494.48 | 4 |
| Michigan | $455.58 | $455.58 | $443.51 - $467.64 | 2 |
| North Carolina | $449.97 | $449.97 | $449.97 - $449.97 | 1 |
| New York | $532.35 | $532.35 | $457.39 - $566.16 | 5 |
| Ohio | $443.03 | $443.03 | $443.03 - $443.03 | 1 |
| Pennsylvania | $471.77 | $471.77 | $444.88 - $498.66 | 2 |
| Texas | $473.12 | $473.12 | $441.45 - $503.72 | 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 95813
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95813 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0543T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0548T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0567T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0568T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0569T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0570T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0571T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0572T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0573T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 95813
What does CPT code 95813 mean? +
CPT code 95813 represents: Eeg extnd mntr 61-119 min. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95813? +
The 2026 Medicare national average non-facility payment for CPT 95813 is $498.55. Rates range from $418.31 to $669.93 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95813? +
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 95813? +
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 May 31, 2026.
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