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

Reports a routine EEG recording that captures wakefulness and drowsiness, commonly used to evaluate seizures, episodic altered awareness, or other suspected cerebral dysfunction.

CMS RVU26DEffective Oct 1, 2026One payment locality300.1K Medicare services in 2024

In Kentucky, Medicare pays $371.58 for 95816 in the office.

$371.58Office (non-facility)
Not available in this settingHospital or facility
−10.1%vs the national office rate ($413.50)

Check a contract rate as a % of Medicare · 95816 nationwide

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

We’ll open 95816 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Kentucky
  2. What 95816 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Kentucky compares for 95816

Across 109 of 109 payment localities, the office rate for 95816 runs from $359.00 in Arkansas to $581.60 in San Benito County, CA. Kentucky pays $371.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

95816 in Kentucky vs other payment areas
  1. Kentucky · this page$371.58
  2. Los Angeles, CA · California$482.46+$110.88
  3. Washington, DC area · District of Columbia$482.54+$110.96
  4. Miami, FL · Florida$433.99+$62.41
  5. Chicago, IL · Illinois$419.95+$48.37
  6. Manhattan, NY · New York$478.47+$106.89
  7. Alaska · Alaska$453.92+$82.34

Other areas in Kentucky first, then benchmark localities. Bars start at $0.

Every other payment area

95816 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$365.17—
ArkansasArkansas$359.00—
ArizonaArizona$401.39—
Bakersfield, CACalifornia$448.87—
Chico, CACalifornia$448.56—
El Centro, CACalifornia$448.58—
Fresno, CACalifornia$448.56—
Hanford, CACalifornia$448.56—

95816 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$359.00

$515.08

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
95816 office rate range by state
State / territoryOffice rate rangeLocalities
AK$453.921
AL$365.171
AR$359.001
AZ$401.391
CA$448.56–$581.6029
CO$437.201
CT$443.791
DC$482.541
DE$408.841
FL$398.68–$433.993
GA$373.63–$420.282
GU$463.481
HI$463.481
IA$379.611
ID$381.741
IL$382.75–$426.454
IN$384.401
KS$375.841
KY$371.581
LA$370.23–$391.832
MA$433.27–$487.342
MD$418.08–$482.543
ME$382.23–$408.892
MI$381.30–$402.672
MN$422.031
MO$361.65–$395.513
MS$360.491
MT$413.501
NC$387.171
ND$411.521
NE$382.541
NH$428.461
NJ$449.74–$475.952
NM$383.041
NV$413.321
NY$393.76–$489.505
OH$380.901
OK$372.621
OR$411.01–$454.842
PA$382.56–$430.162
PR$417.581
RI$426.191
SC$384.501
SD$411.291
TN$377.821
TX$379.51–$434.958
UT$390.661
VA$406.14–$482.542
VI$417.581
VT$408.101
WA$433.04–$499.792
WI$395.441
WV$365.811
WY$412.631

See 95816 in every payment locality

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

Office or facility?

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.

The exact Kentucky inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

12,556

Code
95816
Physician work
1.05
Practice expense
11.23
Malpractice
0.10

GPCI2026.csv

55

Locality
Kentucky
Physician work
1.000
Practice expense
0.889
Malpractice
0.915
Office calculation for 95816 in Kentucky
ComponentRVULocality factorAdjusted
Physician work1.05× 1.0001.0500
Practice expense11.23× 0.8899.9835
Malpractice0.10× 0.9150.0915
Total RVUs11.1250
Conversion factor× 33.4009

Office rate, Kentucky$371.58

Office: (1.05 × 1 + 11.23 × 0.889 + 0.1 × 0.915) × $33.4009 = $371.58

Open 95816 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical1Diagnostic 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.

When to use modifier 26

Codes related to 95816

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

Codes related to 95816
CodeHow it relatesOffice range, Kentucky
Same family
95819EEG, awake and asleep recordingEEG sibling for recordings that include awake and asleep states.$432.76
95812EEG monitoring, 41–60 minutesEEG code for a 41–60 minute recording.$344.67
95813EEG recording, 61–119 minutesEEG code for an extended 61–119 minute recording.$432.54
95822EEG, sleep or coma onlyEEG code for a recording limited to coma or sleep.$401.28

How 95816 has changed in Kentucky

95816 · Office / nonfacility

$371.58

Effective 2026-10-01

The base rate is $37.56 higher than on 2025-10-01, moving from $334.02 to $371.58 (11.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $334.02changed to$371.58

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.08 changed to 1.05
    • Practice expense RVU 10.46 changed to 11.23
    • Malpractice RVU 0.08 changed to 0.10
    • Practice expense GPCI 0.877 changed to 0.889
    • Malpractice GPCI 0.913 changed to 0.915

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $350.48changed to$334.02

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.67 changed to 10.46
    • Malpractice RVU 0.10 changed to 0.08

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $344.76changed to$350.48

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $343.08changed to$344.76

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.28 changed to 10.67
    • Malpractice RVU 0.08 changed to 0.10
    • Practice expense GPCI 0.873 changed to 0.877
    • Malpractice GPCI 0.870 changed to 0.913

  5. January 1, 2023

    RVU23A

    $345.79changed to$343.08

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.17 changed to 10.28
    • Malpractice RVU 0.09 changed to 0.08
    • Practice expense GPCI 0.869 changed to 0.873
    • Malpractice GPCI 0.827 changed to 0.870

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $340.77changed to$345.79

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.91 changed to 10.17

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $329.65changed to$340.77

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.14 changed to 9.91
    • Malpractice RVU 0.08 changed to 0.09
    • Practice expense GPCI 0.874 changed to 0.869
    • Malpractice GPCI 0.823 changed to 0.827

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $330.18changed to$329.65

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 9.10 changed to 9.14
    • Malpractice RVU 0.09 changed to 0.08
    • Practice expense GPCI 0.880 changed to 0.874
    • Malpractice GPCI 0.819 changed to 0.823

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $331.72changed to$330.18

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.16 changed to 9.10

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $325.57changed to$331.72

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.04 changed to 9.16
    • Practice expense GPCI 0.876 changed to 0.880
    • Malpractice GPCI 0.807 changed to 0.819

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $324.41changed to$325.57

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.07 changed to 9.04
    • Practice expense GPCI 0.872 changed to 0.876
    • Malpractice GPCI 0.795 changed to 0.807

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $321.56changed to$324.41

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.96 changed to 9.07
    • Malpractice RVU 0.07 changed to 0.09

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $319.96changed to$321.56

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $313.92changed to$319.96

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.74 changed to 8.96
    • Malpractice RVU 0.08 changed to 0.07
    • Malpractice GPCI 0.774 changed to 0.795

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $366.54changed to$313.92

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 11.06 changed to 8.74
    • Practice expense GPCI 0.871 changed to 0.872
    • Malpractice GPCI 0.752 changed to 0.774

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $366.54

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$371.58Not available in this settingRVU26D
2026-07-01$371.58Not available in this settingRVU26C
2026-04-01$371.58Not available in this settingRVU26B
2026-01-01$371.58Not available in this settingRVU26A
2025-10-01$334.02Not available in this settingRVU25D
2025-07-01$334.02Not available in this settingRVU25C
2025-04-01$334.02Not available in this settingRVU25B
2025-01-01$334.02Not available in this settingRVU25A
2024-10-01$350.48Not available in this settingRVU24D
2024-07-01$350.48Not available in this settingRVU24C
2024-04-01$350.48Not available in this settingRVU24B
2024-03-09$350.48Not available in this settingRVU24AR
2024-01-01$344.76Not available in this settingRVU24A
2023-10-01$343.08Not available in this settingRVU23D
2023-07-01$343.08Not available in this settingRVU23C
2023-04-01$343.08Not available in this settingRVU23B
2023-01-01$343.08Not available in this settingRVU23A
2022-10-01$345.79Not available in this settingRVU22D
2022-07-01$345.79Not available in this settingRVU22C
2022-04-01$345.79Not available in this settingRVU22B
2022-01-01$345.79Not available in this settingRVU22A
2021-10-01$340.77Not available in this settingRVU21D
2021-07-01$340.77Not available in this settingRVU21C
2021-04-01$340.77Not available in this settingRVU21B
2021-01-01$340.77Not available in this settingRVU21A
2020-10-01$329.65Not available in this settingRVU20D
2020-07-01$329.65Not available in this settingRVU20C
2020-04-01$329.65Not available in this settingRVU20B
2020-01-01$329.65Not available in this settingRVU20A
2019-10-01$330.18Not available in this settingRVU19D
2019-07-01$330.18Not available in this settingRVU19C
2019-04-01$330.18Not available in this settingRVU19B
2019-01-01$330.18Not available in this settingRVU19A
2018-10-01$331.72Not available in this settingRVU18D
2018-07-01$331.72Not available in this settingRVU18C
2018-04-01$331.72Not available in this settingRVU18B
2018-01-01$331.72Not available in this settingRVU18AR1
2017-10-01$325.57Not available in this settingRVU17D
2017-07-01$325.57Not available in this settingRVU17C
2017-04-01$325.57Not available in this settingRVU17B
2017-01-01$325.57Not available in this settingRVU17A
2016-10-01$324.41Not available in this settingRVU16D
2016-07-01$324.41Not available in this settingRVU16C
2016-04-01$324.41Not available in this settingRVU16B
2016-01-01$324.41Not available in this settingRVU16A
2015-10-01$321.56Not available in this settingRVU15D
2015-07-01$321.56Not available in this settingRVU15C
2015-04-01$319.96Not available in this settingRVU15B
2015-01-01$319.96Not available in this settingRVU15A
2014-10-01$313.92Not available in this settingRVU14D
2014-07-01$313.92Not available in this settingRVU14C
2014-04-01$313.92Not available in this settingRVU14B
2014-01-01$313.92Not available in this settingRVU14A
2013-10-01$366.54Not available in this settingRVU13D
2013-07-01$366.54Not available in this settingRVU13C
2013-04-01$366.54Not available in this settingRVU13B
2013-01-01$366.54Not available in this settingRVU13AR

Price 95816 for an earlier date of service

Where the Kentucky rate applies

Kentucky is a Medicare payment area, not a city. Our Census mapping connects it to 553 cities and communities in Kentucky. Some span more than one payment area; confirm with the service ZIP.

  • Adairville
  • Ages
  • Albany
  • Alexandria
  • Allen
  • Allensville
  • Anchorage
  • Annville

Browse all communities in Kentucky

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

Show the CMS file lines behind this rate
RVUs for 95816PPRRVU2026_Oct_nonQPP.csv, line 12,556 (RVU26D)
Geographic factors for KentuckyGPCI2026.csv, line 55 (RVU26D)

Open CMS sourceHow we calculate rates

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