How much does Medicare pay for CPT 95813?

Medicare allowed an average of $202.49 per service and paid $158.20 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $738.03, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95813?

Measurement of brain wave activity (eeg), 61-119 minutes. It was billed 22,153 times to 21,370 Medicare beneficiaries by 539 providers in 2024.

Does 95813 pay differently in an office than a hospital?

Yes. The allowed amount averaged $432.35 in an office setting and $85.35 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 95813 most?

Neurology, with 20,756 services from 510 clinicians. Next are Independent Diagnostic Testing Facility (IDTF), Audiologist, Neuropsychiatry.

CPT 95813

Measurement of brain wave activity (eeg), 61-119 minutes

$202.49Medicare-allowed amount per service, averaged across 22,153 services

Providers submitted

$738.03

Asking price, not received

Medicare allowed

$202.49

The fee schedule figure

Medicare paid

$158.20

Balance is patient coinsurance

Providers submitted an average of $738.03 for this code and Medicare allowed $202.49 — 3.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $158.20 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $432.35
Hospital / facility: $85.35

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 7,478 services were billed in an office setting and 14,675 in a facility.

Services: 22,153
Beneficiaries: 21,370
Providers billing it: 539
Total allowed: $4,485,761

What Medicare pays for CPT 95813

Across 22,153 services billed by 539 providers to 21,370 beneficiaries, Medicare allowed an average of $202.49 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 95813

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	20,756	20,007	$201.57	510
Independent Diagnostic Testing Facility (IDTF)	431	427	$408.22	5
Audiologist	285	272	$94.44	1
Neuropsychiatry	211	208	$81.99	7
Critical Care (Intensivists)	116	109	$81.01	4
Pediatric Medicine	97	96	$420.09	3
Psychiatry	55	54	$81.02	2
Anesthesiology	51	49	$88.80	1
Neurosurgery	47	45	$89.23	1
Epileptologists	45	45	$84.18	2
Undefined Physician type	30	30	$85.10	1
Family Practice	16	16	$432.45	1
Cardiology	13	12	$390.54	1

95813 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	2,463	$263.47	$213.54	48
New York	2,299	$210.49	$146.81	49
New Jersey	1,809	$359.59	$246.72	32
California	1,719	$281.67	$197.80	41
Massachusetts	1,406	$125.05	$89.82	23
Florida	1,333	$310.63	$253.94	31
Arizona	918	$261.04	$213.74	13
Kansas	834	$101.54	$81.71	12
Georgia	829	$160.90	$130.76	23
South Carolina	784	$93.34	$72.79	12
Washington	674	$117.81	$88.36	15
Ohio	612	$110.09	$83.51	21
Maryland	522	$328.37	$228.09	14
Mississippi	512	$109.77	$92.91	6
Pennsylvania	479	$85.02	$63.95	21
Iowa	388	$78.01	$62.87	9
Colorado	379	$81.73	$63.50	14
Connecticut	317	$86.31	$65.17	8
Illinois	315	$97.51	$72.37	18
Utah	315	$107.72	$78.04	2
Minnesota	311	$291.86	$223.26	11
Kentucky	280	$94.11	$75.94	11
Louisiana	275	$245.98	$225.00	11
Tennessee	272	$161.24	$135.73	13
Missouri	269	$106.38	$86.47	13
Michigan	261	$171.61	$133.16	9
Nevada	206	$229.00	$181.46	4
Oklahoma	196	$101.23	$80.96	6
District of Columbia	167	$91.08	$63.58	2
West Virginia	115	$147.38	$107.92	7
North Carolina	111	$234.10	$169.11	6
New Mexico	109	$82.80	$63.02	5
Wisconsin	107	$163.38	$135.66	7
Alabama	107	$167.69	$144.40	2
Arkansas	73	$78.20	$62.27	3
Nebraska	68	$80.91	$65.62	2
Virginia	64	$82.21	$65.53	2
Indiana	63	$123.78	$108.57	3
Delaware	61	$358.36	$284.01	3
New Hampshire	61	$83.32	$62.38	3
Oregon	36	$80.58	$64.71	2
Alaska	22	$104.69	$64.67	1
Montana	12	$82.27	$65.58	1

Related codes

95886Needle measurement of electrical activity in arm or leg muscles$86.76
95816Measurement of brain wave activity (eeg)$227.96
95811Sleep study in sleep lab$314.61
95810Sleep study in sleep lab (6 years or older)$309.74
95800Sleep study including heart rate$117.17
95819Measurement of brain wave activity (eeg)$239.95
95885Needle measurement of electrical activity in arm or leg muscles$46.74
95806Sleep study including heart rate$54.06
95874Needle measurement of electrical activity in muscle$53.46
95861Needle measurement of electrical activity in arm or leg muscles$80.08
95870Needle measurement of electrical activity in arm$19.70
95812Measurement of brain wave activity (eeg)$191.83

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.