Billing code 95919: PupillometryMedicare rate & RVUs in Delaware
Reports quantitative measurement of pupil responses with a physician or qualified health care professional’s interpretation, for one or both eyes.
Medicare pays $16.54 for 95919 in the office in Delaware (Delaware). 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.
On this page 9 sections
What 95919 covers
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.
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 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $16.54 | Unavailable |
How the 95919 rate is calculated
Each of 95919’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 · 95919
RVUs × geographic indexes × conversion factor
Work0.18
0.18 RVUs× 1.000 GPCI
Practice expense0.30
0.30 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
0.5000
Conversion factor
$33.4009
Medicare rate
$16.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95919
The CMS indicators that decide how 95919 is paid alongside other services.
CMS payment indicators · 95919
Pupillometry
| 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
95919 without 26 · national office
$16.70
Pupillometry
95919-26 · Professional component
$10.02
Pays only the interpretation and report.
95919 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95921Autonomic testing
- Use 95919 for quantitative pupil measurements and their interpretation. Use 95921 when the service assesses parasympathetic autonomic function.
- 95922Autonomic testing
- Use 95922 for adrenergic autonomic testing, not for a quantitative assessment of pupil responses.
- 95923Sweat function test
- 95923 reports autonomic function testing; 95919 reports quantitative pupillometry. Select according to the test actually performed and interpreted.
- 95924Autonomic testing
- 95924 describes combined parasympathetic and sympathetic testing with tilt. It is not a substitute for reporting quantitative pupil measurements.
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 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
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