Billing code 95813: EEG recordingMedicare rate & RVUs in Illinois
Report this extended EEG service for a diagnostic recording lasting 61–119 minutes, such as evaluation of suspected seizures or episodic altered awareness.
Medicare pays $445.25–$494.48 for 95813 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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 95813 covers
This service covers an extended scalp electroencephalogram recording, with cerebral electrical activity acquired for 61 through 119 minutes. It may be used when a clinician needs a longer diagnostic sample, such as when evaluating suspected seizures, spells of altered awareness, or abnormal mental status. An EEG technologist typically applies the electrodes and acquires the tracing in an outpatient EEG laboratory or hospital; a qualified physician reviews and interprets it.
Select the code from the actual EEG recording duration, not the appointment length or interpretation time. A 41–60-minute recording falls under 95812; other EEG codes may be selected based on the recorded sleep or wake state or clinical circumstance. Documentation should identify the indication, recording duration, technical circumstances, and physician interpretation. CMS recognizes professional and technical components: report modifier 26 for interpretation, modifier TC for equipment and staff, or no component modifier for the global service.
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 95813 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$445.25 to $494.48
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $487.31 | Unavailable |
| East St. Louis | $450.01 | Unavailable |
| Rest Of Illinois | $445.25 | Unavailable |
| Suburban Chicago | $494.48 | Unavailable |
How the 95813 rate is calculated
Each of 95813’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 · 95813
RVUs × geographic indexes × conversion factor
Work1.63
1.63 RVUs× 1.000 GPCI
Practice expense12.61
12.61 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
14.3600
Conversion factor
$33.4009
Medicare rate
$479.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95813
The CMS indicators that decide how 95813 is paid alongside other services.
CMS payment indicators · 95813
EEG recording
| 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
95813 without 26 · national office
$479.64
EEG recording
95813-26 · Professional component
$88.18
Pays only the interpretation and report.
95813 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95812EEG monitoring
- This code covers 61–119 minutes of EEG recording; 95812 covers the shorter 41–60-minute duration.
- 95816EEG
- 95816 identifies an EEG capturing awake and drowsy states. Choose 95813 based on its 61–119-minute recording duration.
- 95819EEG
- 95819 identifies an EEG capturing awake and asleep states. 95813 is selected for a 61–119-minute recording.
- 95822EEG
- 95822 is for an EEG performed in coma or during sleep only; 95813 is distinguished by a 61–119-minute recording.
95813 billing questions
When does 95813 apply instead of 95812?
Use 95813 for an EEG recording lasting 61–119 minutes. A 41–60-minute recording falls under 95812.
Should the appointment length determine the code?
No. Select the code using the EEG recording duration, rather than the time spent checking in, applying electrodes, or discussing results.
How are the professional and technical portions reported?
Use modifier 26 for the professional interpretation and modifier TC for the technical portion involving equipment and staff. Without either modifier, the claim represents the global service.
What documentation supports 95813?
Document the clinical indication, the EEG recording duration, the technical circumstances, and the physician's interpretation.
How does 95813 differ from an awake-and-asleep EEG?
95813 is selected by recording duration. Codes such as 95819 describe an EEG capturing specified wake and sleep states, so the recorded state and service circumstances guide that choice.
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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