CPT code 95816: EEG, awake and drowsy2026 Medicare rate & RVUs

Medicare pays $413.50 for 95816 nationally in the office. Local office rates run $359.00–$581.60.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 95816 covers

This service records electrical activity from scalp electrodes while the patient is awake and drowsy. EEG technologists typically apply the electrodes and acquire the tracing in an outpatient neurodiagnostic lab, hospital, or clinic; a neurologist or other qualified physician interprets the results. It is commonly ordered when evaluating suspected seizures, unexplained spells, or changes in awareness. The state captured matters: this code describes an awake-and-drowsy study, not one that documents sleep.

Select the code based on the recording performed, rather than the reason for the referral. The report should identify the recorded states and include the physician’s interpretation. CMS recognizes professional and technical components: modifier 26 represents interpretation, modifier TC represents the equipment and staff, and reporting without either modifier represents the global service. When the professional and technical portions are furnished and billed separately, each portion is reported by the entity that furnished it.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 95816 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

95816 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 95816 rate is calculated

Each of 95816’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 95816

The CMS indicators that decide how 95816 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

95816 compared with similar codes

How to choose

95819EEGAwake and asleep recording

Choose 95816 for an awake-and-drowsy recording; 95819 applies when the recording includes sleep as well.

95812EEG monitoring41–60 minutes

95812 identifies an EEG by a 41–60 minute recording duration. 95816 identifies the awake-and-drowsy states rather than that duration range.

95813EEG recording61–119 minutes

95813 applies to an extended EEG recording of 61–119 minutes. Use 95816 for the awake-and-drowsy study when the extended-duration criteria are not the basis for code selection.

Codes related to 95816

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates