CPT 95816
Global XXX ActiveEeg awake and drowsy
CPT 95816 Billing & Documentation Guide
CPT code 95816 (Eeg awake and drowsy) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.05, a non-facility practice expense RVU of 11.23, and a malpractice RVU of 0.1, a total non-facility RVU of 12.38 and facility RVU of 12.38. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $430.11, though rates vary from $359 to $581.6 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95816, 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 95816 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 95816 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 95816
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.05 | 1.05 |
| Practice Expense RVU | 11.23 | 11.23 |
| Malpractice RVU | 0.1 | 0.1 |
| Total RVU | 12.38 | 12.38 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95816
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 | $481.98 | $481.98 | $448.56 - $581.6 | 29 |
| Florida | $417.92 | $417.92 | $398.68 - $433.99 | 3 |
| Georgia | $396.96 | $396.96 | $373.63 - $420.28 | 2 |
| Illinois | $404.01 | $404.01 | $382.75 - $426.45 | 4 |
| Michigan | $391.99 | $391.99 | $381.3 - $402.67 | 2 |
| North Carolina | $387.17 | $387.17 | $387.17 - $387.17 | 1 |
| New York | $459.73 | $459.73 | $393.76 - $489.5 | 5 |
| Ohio | $380.9 | $380.9 | $380.9 - $380.9 | 1 |
| Pennsylvania | $406.36 | $406.36 | $382.56 - $430.16 | 2 |
| Texas | $407.64 | $407.64 | $379.51 - $434.95 | 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 95816
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95816 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 95816
What does CPT code 95816 mean? +
CPT code 95816 represents: Eeg awake and drowsy. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95816? +
The 2026 Medicare national average non-facility payment for CPT 95816 is $430.11. Rates range from $359 to $581.6 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95816? +
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 95816? +
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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