How much does Medicare pay for CPT 95816?

Medicare allowed an average of $227.96 per service and paid $179.15 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $512.52, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95816?

Measurement of brain wave activity (eeg), awake and drowsy. It was billed 285,169 times to 203,317 Medicare beneficiaries by 3,782 providers in 2024.

Does 95816 pay differently in an office than a hospital?

Yes. The allowed amount averaged $376.57 in an office setting and $56.32 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 95816 most?

Neurology, with 190,540 services from 3,361 clinicians. Next are Nurse Practitioner, Family Practice, Internal Medicine.

CPT 95816

Measurement of brain wave activity (eeg), awake and drowsy

$227.96Medicare-allowed amount per service, averaged across 285,169 services

Providers submitted

$512.52

Asking price, not received

Medicare allowed

$227.96

The fee schedule figure

Medicare paid

$179.15

Balance is patient coinsurance

Providers submitted an average of $512.52 for this code and Medicare allowed $227.96 — 2.2× 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 $179.15 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $376.57
Hospital / facility: $56.32

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. 152,841 services were billed in an office setting and 132,328 in a facility.

Services: 285,169
Beneficiaries: 203,317
Providers billing it: 3,782
Total allowed: $65,007,125

What Medicare pays for CPT 95816

Across 285,169 services billed by 3,782 providers to 203,317 beneficiaries, Medicare allowed an average of $227.96 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. 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 95816

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	190,540	182,270	$160.45	3,361
Nurse Practitioner	57,632	3,861	$360.22	101
Family Practice	11,115	1,691	$429.73	48
Internal Medicine	6,043	3,742	$395.74	77
Physician Assistant	5,728	495	$365.32	14
Independent Diagnostic Testing Facility (IDTF)	3,093	3,017	$384.40	23
Psychiatry	1,987	887	$325.67	21
General Practice	1,314	1,269	$439.53	11
Emergency Medicine	1,230	114	$380.79	3
Neuropsychiatry	1,071	859	$192.33	24
Cardiology	745	717	$422.08	4
Epileptologists	604	596	$159.13	12
Sleep Medicine	520	512	$101.13	9
Neurosurgery	470	445	$185.74	10
Obstetrics & Gynecology	374	352	$396.23	3

95816 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
California	78,213	$355.87	$243.00	404
New York	25,249	$280.03	$190.20	308
Texas	19,540	$214.27	$172.79	336
Florida	19,427	$183.81	$144.05	349
New Jersey	9,719	$212.79	$149.14	129
Nevada	9,546	$158.90	$127.69	73
Missouri	9,320	$204.55	$182.76	83
Ohio	8,647	$122.99	$98.94	151
Pennsylvania	8,369	$72.94	$57.06	166
Michigan	7,894	$252.83	$194.05	115
Arizona	6,605	$259.39	$214.39	90
Illinois	5,878	$89.88	$72.10	137
Massachusetts	5,576	$151.63	$106.57	87
Georgia	5,445	$160.38	$121.77	114
Virginia	5,347	$212.90	$154.27	93
North Carolina	5,180	$164.04	$135.90	106
Maryland	4,647	$145.25	$108.05	72
South Carolina	4,541	$136.67	$114.27	68
Indiana	4,518	$112.27	$93.38	91
Tennessee	4,344	$115.61	$99.56	84
Kentucky	2,878	$71.96	$58.54	53
Louisiana	2,805	$152.09	$128.73	47
Utah	2,522	$274.86	$232.21	10
Oklahoma	2,412	$176.20	$151.33	35
Alabama	2,391	$125.86	$111.47	58
Mississippi	2,139	$120.84	$105.77	29
Arkansas	2,136	$185.02	$156.54	38
Washington	2,067	$95.78	$67.83	52
Connecticut	1,989	$65.29	$46.48	32
Minnesota	1,864	$103.94	$79.57	54
West Virginia	1,656	$164.88	$151.84	11
Colorado	1,553	$163.33	$126.36	33
Wisconsin	1,484	$70.58	$56.46	53
District of Columbia	1,129	$211.09	$143.70	12
Rhode Island	914	$193.36	$140.75	17
Kansas	813	$67.79	$55.45	19
Delaware	803	$68.37	$54.48	12
New Hampshire	793	$55.94	$41.46	21
South Dakota	620	$53.35	$41.79	13
Iowa	618	$52.21	$42.70	16
Oregon	571	$78.33	$59.80	21
Hawaii	464	$233.68	$165.24	9
Nebraska	419	$52.74	$41.84	16
Maine	388	$74.29	$51.00	9
North Dakota	386	$75.47	$58.69	12
New Mexico	348	$178.61	$150.32	7
Idaho	294	$53.07	$41.55	8
Montana	198	$78.35	$60.67	9
Vermont	192	$52.63	$42.20	6
Puerto Rico	128	$347.28	$272.09	7
Wyoming	120	$324.06	$253.63	4
U.S. Virgin Islands	37	$389.92	$305.04	1
Alaska	33	$69.81	$39.70	2

Related codes

95886Needle measurement of electrical activity in arm or leg muscles$86.76
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
95813Measurement of brain wave activity (eeg)$202.49
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.