CPT code 95816: EEG, awake and drowsy2026 Medicare rate & RVUs in Guam
Reports a routine EEG recording that captures wakefulness and drowsiness, commonly used to evaluate seizures, episodic altered awareness, or other suspected cerebral dysfunction.
Medicare pays $463.48 for 95816 in the office in Guam (Hawaii, Guam, HI). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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.
95816 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | $463.48 | Unavailable |
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.
How the rate is built · 95816
RVUs × geographic indexes × conversion factor
Work1.05
1.05 RVUs× 1.000 GPCI
Practice expense11.23
11.23 RVUs× 1.000 GPCI
Malpractice0.10
0.10 RVUs× 1.000 GPCI
Adjusted RVUs
12.3800
Conversion factor
$33.4009
Medicare rate
$413.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95816
The CMS indicators that decide how 95816 is paid alongside other services.
CMS payment indicators · 95816
EEG, awake and drowsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
95816 without 26 · national office
$413.50
EEG, awake and drowsy
95816-26 · Professional component
$56.45
Pays only the interpretation and report.
95816 compared with similar codes
Compare codes · National
4 codes, side by side
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.
95816 billing questions
How does this differ from 95819?
Use 95816 when the recording captures wakefulness and drowsiness. Use 95819 when the EEG also documents sleep.
Which modifiers identify the EEG components?
Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service, including equipment and staff. Report the global service without either modifier when billing both components together.
What documentation supports reporting 95816?
The record should support that an EEG was performed and identify the states captured; the interpreting physician’s report should document the findings and interpretation.
Is this code selected by recording minutes?
95816 identifies an awake-and-drowsy study, not a stated minute range. Codes 95812 and 95813 describe EEG recordings by longer duration ranges.
Can the technical and professional portions be billed separately?
Yes. Report the interpretation with modifier 26 and the technical portion with modifier TC when those portions are furnished and billed separately.
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
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