$371.58
Use 95816 for awake-and-drowsy recording. Use 95819 when the EEG includes sleep recording as well as wakefulness.
On this page
CMS RVU26D · Effective 2026-10-01
95819 EEG Medicare reimbursement rates in Kentucky
Reports a scalp EEG that records both wakefulness and sleep when evaluating suspected seizures, episodic altered awareness, or other cerebral dysfunction. Compare 95819 office and facility rates across CMS payment localities in Kentucky.
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 95819 in Kentucky?
Kentucky 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
$432.76
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Neurology diagnostic testing
About 95819: Awake-and-sleep scalp EEG recording
Reports a scalp EEG that records both wakefulness and sleep when evaluating suspected seizures, episodic altered awareness, or other cerebral dysfunction.
A technologist places scalp electrodes and records brain electrical activity during wakefulness and sleep. A physician, commonly a neurologist, interprets the tracing. The study may be performed in an outpatient diagnostic department, clinic, or hospital when a clinician needs to assess events such as suspected seizures or episodes of altered awareness and wants both states represented in the recording.
Choose this code when the EEG includes awake and sleep recording, rather than selecting solely by the patient’s presenting symptom. The report should identify the states captured and include the interpretation; the technical record supports the equipment and staff portion. CMS recognizes separately priced professional and technical components: report modifier 26 for the interpretation and modifier TC for the equipment and staff. Without either modifier, the claim represents the global service.
CMS billing rules for 95819
- 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 RVU1.05 · 7%
- Practice expense (office) RVU13.28 · 92%
- Malpractice RVU0.11 · 1%
154.9K
Medicare services in 2024 · #443 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.
95819 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$401.28
95822 describes an EEG recorded only during sleep or coma; 95819 includes both awake and sleep states.
$344.67
95812 is associated with a specified recording-duration range. 95819 is distinguished by recording both awake and sleep states.
$432.54
95813 is associated with a longer specified recording-duration range. Select 95819 when the documented service is an awake-and-sleep EEG rather than by duration.
Compare 95819 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
Kentucky →
Office / nonfacility
$432.76
Facility
Unavailable
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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 95819 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
12,559
- Code
- 95819
- Physician work
- 1.05
- Practice expense
- 13.28
- Malpractice
- 0.11
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.05 | × 1.000 | 1.0500 |
| Practice expense | 13.28 | × 0.889 | 11.8059 |
| Malpractice | 0.11 | × 0.915 | 0.1007 |
| Total RVUs | 12.9566 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$432.76
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.05 | 1 |
| Practice expense | 13.28 | 0.889 |
| Malpractice | 0.11 | 0.915 |
(1.05 × 1 + 13.28 × 0.889 + 0.11 × 0.915) × $33.4009 = $432.76
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.
95819 billing questions
How does this differ from 95816?
95819 represents an EEG with awake and sleep recording. 95816 is the closer choice when the recording is awake and drowsy rather than asleep.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical portion. Without a modifier, the service is billed globally.
What documentation supports reporting 95819?
The EEG record and report should support that both awake and sleep states were recorded, with the physician’s interpretation documented.
Is code selection based on recording time?
This code distinguishes the awake-and-sleep recording pattern. Codes 95812 and 95813 are associated with specified recording-duration ranges, so review the actual service and documentation when choosing between them.
When is 95822 a better fit?
95822 is for an EEG recorded only during sleep or coma. Use 95819 when the study includes both awake and sleep recording.
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.
12,55695816,,Eeg awake and drowsy,A,,1.05,11.23,,11.23,NA,0.10,12.38,12.38,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,55795816,26,Eeg awake and drowsy,A,,1.05,0.59,,0.59,,0.05,1.69,1.69,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,55895816,TC,Eeg awake and drowsy,A,,0.00,10.64,,10.64,NA,0.05,10.69,10.69,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,55995819,,Eeg awake and asleep,A,,1.05,13.28,,13.28,NA,0.11,14.44,14.44,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,56095819,26,Eeg awake and asleep,A,,1.05,0.60,,0.60,,0.05,1.70,1.70,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,56195819,TC,Eeg awake and asleep,A,,0.00,12.68,,12.68,NA,0.06,12.74,12.74,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,56295822,,Eeg coma or sleep only,A,,1.05,12.23,,12.23,NA,0.10,13.38,13.38,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631