CPT 95836
Global XXX ActiveEcog impltd brn npgt <30 d
CPT 95836 Billing & Documentation Guide
CPT code 95836 (Ecog impltd brn npgt <30 d) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.93, a non-facility practice expense RVU of 1.12, and a malpractice RVU of 0.16, a total non-facility RVU of 3.21 and facility RVU of 2.65. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $109.4, though rates vary from $99.35 to $139.48 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95836, 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 95836 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 95836 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 95836
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.93 | 1.93 |
| Practice Expense RVU | 1.12 | 0.56 |
| Malpractice RVU | 0.16 | 0.16 |
| Total RVU | 3.21 | 2.65 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95836
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 | $113.93 | $91.8 | $109.42 - $128.36 | 29 |
| Florida | $112.4 | $93.63 | $108.26 - $116.92 | 3 |
| Georgia | $106.64 | $88.8 | $104.2 - $109.08 | 2 |
| Illinois | $111.05 | $92.97 | $106.97 - $114.78 | 4 |
| Michigan | $107.11 | $89.54 | $104.65 - $109.57 | 2 |
| North Carolina | $102.78 | $85.33 | $102.78 - $102.78 | 1 |
| New York | $116.52 | $95.65 | $103.76 - $122.99 | 5 |
| Ohio | $104.01 | $86.93 | $104.01 - $104.01 | 1 |
| Pennsylvania | $107.4 | $89.08 | $103.86 - $110.94 | 2 |
| Texas | $106.61 | $88.2 | $103.47 - $109.48 | 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 95836
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95836 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 |
| 0734T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0858T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 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 |
| 95824 | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 95957 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 98975 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 98976 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 95836
What does CPT code 95836 mean? +
CPT code 95836 represents: Ecog impltd brn npgt <30 d. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95836? +
The 2026 Medicare national average non-facility payment for CPT 95836 is $109.4. Rates range from $99.35 to $139.48 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95836? +
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 95836? +
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 2, 2026.
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