CPT 95970
Global XXX ActiveAlys npgt w/o prgrmg
CPT 95970 Billing & Documentation Guide
CPT code 95970 (Alys npgt w/o prgrmg) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.35, a non-facility practice expense RVU of 0.21, and a malpractice RVU of 0.03, a total non-facility RVU of 0.59 and facility RVU of 0.48. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $20.11, though rates vary from $18.23 to $25.56 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95970, 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 95970 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 95970 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 95970
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.35 | 0.35 |
| Practice Expense RVU | 0.21 | 0.1 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 0.59 | 0.48 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95970
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 | $20.95 | $16.61 | $20.11 - $23.63 | 29 |
| Florida | $20.68 | $16.99 | $19.9 - $21.53 | 3 |
| Georgia | $19.6 | $16.09 | $19.14 - $20.06 | 2 |
| Illinois | $20.42 | $16.88 | $19.66 - $21.12 | 4 |
| Michigan | $19.69 | $16.24 | $19.23 - $20.15 | 2 |
| North Carolina | $18.87 | $15.45 | $18.87 - $18.87 | 1 |
| New York | $21.43 | $17.33 | $19.06 - $22.64 | 5 |
| Ohio | $19.1 | $15.75 | $19.1 - $19.1 | 1 |
| Pennsylvania | $19.74 | $16.13 | $19.08 - $20.4 | 2 |
| Texas | $19.59 | $15.97 | $19 - $20.13 | 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 95970
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95970 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0162T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0282T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0283T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0284T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0285T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0317T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0434T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0435T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0436T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0587T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 95970
What does CPT code 95970 mean? +
CPT code 95970 represents: Alys npgt w/o prgrmg. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95970? +
The 2026 Medicare national average non-facility payment for CPT 95970 is $20.11. Rates range from $18.23 to $25.56 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95970? +
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 95970? +
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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