$82.17
Use 95919 for quantitative pupil measurements and their interpretation. Use 95921 when the service assesses parasympathetic autonomic function.
On this page
CMS RVU26D · Effective 2026-10-01
95919 Pupillometry Medicare reimbursement rates in Alabama
Reports quantitative measurement of pupil responses with a physician or qualified health care professional’s interpretation, for one or both eyes. Compare 95919 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 95919 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$15.16
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Neurologic testing
About 95919: Quantitative pupillometry assessment
Reports quantitative measurement of pupil responses with a physician or qualified health care professional’s interpretation, for one or both eyes.
This service uses a quantitative pupillometer to measure pupil characteristics and responses, rather than relying only on a visual examination. A physician or other qualified health care professional interprets the measurements and prepares a report. Neurology and neurocritical care teams may use it when assessing neurologic status, including in patients with acute brain injury or altered responsiveness. It may be performed in an office or hospital setting, depending on the patient’s care.
Report the service for quantitative pupillometry of one or both eyes; the code covers either extent. Documentation should identify the clinical reason for testing, the measurements obtained, and the interpretation and report. CMS recognizes separately priced professional and technical components: modifier 26 identifies the interpretation, while modifier TC identifies the equipment and staff portion. Reporting without either modifier represents the global service, including both components.
CMS billing rules for 95919
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Where the value comes from
- Work RVU0.18 · 36%
- Practice expense (office) RVU0.30 · 60%
- Malpractice RVU0.02 · 4%
3K
Medicare services in 2024 · #2166 by national volume
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.
95919 compared with similar codes
Office rates for Alabama, from the same CMS release.
$83.28
Use 95922 for adrenergic autonomic testing, not for a quantitative assessment of pupil responses.
$110.42
95923 reports autonomic function testing; 95919 reports quantitative pupillometry. Select according to the test actually performed and interpreted.
$141.51
95924 describes combined parasympathetic and sympathetic testing with tilt. It is not a substitute for reporting quantitative pupil measurements.
Compare 95919 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$15.16
Facility
Unavailable
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 95919 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
12,651
- Code
- 95919
- Physician work
- 0.18
- Practice expense
- 0.30
- Malpractice
- 0.02
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.18 | × 1.000 | 0.1800 |
| Practice expense | 0.30 | × 0.875 | 0.2625 |
| Malpractice | 0.02 | × 0.566 | 0.0113 |
| Total RVUs | 0.4538 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$15.16
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.18 | 1 |
| Practice expense | 0.3 | 0.875 |
| Malpractice | 0.02 | 0.566 |
(0.18 × 1 + 0.3 × 0.875 + 0.02 × 0.566) × $33.4009 = $15.16
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
95919 billing questions
Does testing both eyes require two units?
The code covers quantitative pupillometry of one or both eyes. Document which eyes were tested, but do not report separate units solely because both eyes were measured.
When should modifier 26 be used?
Use modifier 26 for the physician or qualified health care professional’s interpretation and report when billing only the professional component.
When should modifier TC be used?
Use modifier TC for the technical portion, which represents the equipment and staff, when billing that portion separately.
What does reporting without a modifier represent?
An unmodified service represents the global service, combining the professional interpretation and the technical component.
How is this different from autonomic function testing?
This code reports quantitative pupil measurement and interpretation. Codes 95921–95924 describe other autonomic testing methods, such as tests of parasympathetic or adrenergic function.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,64895913,,Nrv cndj test 13/> studies,A,,3.47,5.35,,5.35,NA,0.16,8.98,8.98,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,64995913,26,Nrv cndj test 13/> studies,A,,3.47,2.01,,2.01,,0.14,5.62,5.62,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,65095913,TC,Nrv cndj test 13/> studies,A,,0.00,3.34,,3.34,NA,0.02,3.36,3.36,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,65195919,,Quan puplmtry phy/qhp uni/bi,A,,0.18,0.30,,0.30,NA,0.02,0.50,0.50,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,65295919,26,Quan puplmtry phy/qhp uni/bi,A,,0.18,0.11,,0.11,,0.01,0.30,0.30,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,65395919,TC,Quan puplmtry phy/qhp uni/bi,A,,0.00,0.19,,0.19,NA,0.01,0.20,0.20,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,0.00,0.00,0.00
12,65495921,,Autonomic nrv parasym inervj,A,,0.88,1.78,,1.78,NA,0.04,2.70,2.70,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515