CPT 95819
Global XXX ActiveEeg awake and asleep
CPT 95819 Billing & Documentation Guide
CPT code 95819 (Eeg awake and asleep) 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 13.28, and a malpractice RVU of 0.11, a total non-facility RVU of 14.44 and facility RVU of 14.44. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $501.85, though rates vary from $417.98 to $680.52 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95819, 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 95819 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 95819 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 95819
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.05 | 1.05 |
| Practice Expense RVU | 13.28 | 13.28 |
| Malpractice RVU | 0.11 | 0.11 |
| Total RVU | 14.44 | 14.44 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95819
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 | $563.18 | $563.18 | $523.78 - $680.52 | 29 |
| Florida | $487.26 | $487.26 | $464.64 - $506.11 | 3 |
| Georgia | $462.68 | $462.68 | $435.11 - $490.25 | 2 |
| Illinois | $470.81 | $470.81 | $445.79 - $497.37 | 4 |
| Michigan | $456.75 | $456.75 | $444.19 - $469.3 | 2 |
| North Carolina | $451.26 | $451.26 | $451.26 - $451.26 | 1 |
| New York | $536.57 | $536.57 | $459.04 - $571.54 | 5 |
| Ohio | $443.75 | $443.75 | $443.75 - $443.75 | 1 |
| Pennsylvania | $473.78 | $473.78 | $445.73 - $501.84 | 2 |
| Texas | $475.37 | $475.37 | $442.13 - $507.69 | 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 95819
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95819 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 95819
What does CPT code 95819 mean? +
CPT code 95819 represents: Eeg awake and asleep. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95819? +
The 2026 Medicare national average non-facility payment for CPT 95819 is $501.85. Rates range from $417.98 to $680.52 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95819? +
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 95819? +
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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