Summary & Overview
CPT 95819: Electroencephalogram Recording Awake and Asleep
CPT code 95819 is a critical billing code for electroencephalogram (EEG) procedures that involve recording brain activity during both awake and asleep states, often with additional stimulation techniques such as hyperventilation or photic stimulation. This code is widely used in neurology and electroencephalography practices to assess and diagnose a range of neurological disorders, including epilepsy, convulsions, and syncope. The procedure is commonly performed in office and hospital outpatient settings, reflecting its importance in both routine and acute neurological evaluations.
Major national payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, relevant clinical indications, and associated billing modifiers. Readers will gain insights into current policy updates, clinical benchmarks, and the broader context of EEG utilization in neurological care. The summary also highlights related CPT codes and associated physician taxonomies, offering a clear understanding of how this procedure fits within the spectrum of neurodiagnostic services. This information is essential for stakeholders seeking to understand the national landscape of EEG billing and coverage.
CPT Code Overview
CPT code 95819 represents an electroencephalogram (EEG) procedure that includes recording both awake and asleep states. This comprehensive EEG may involve hyperventilation and/or photic stimulation when clinically appropriate. The service is typically performed in a neurology or electroencephalography setting, with common sites of service including the office (POS 11) or hospital outpatient (POS 22) environments. This procedure is essential for evaluating and diagnosing neurological conditions that affect brain activity.
Clinical & Coding Specifications
Clinical Context
A patient presents to a neurology clinic or hospital outpatient department with episodes of unexplained loss of consciousness, convulsions, or disorientation. The neurologist orders an electroencephalogram (EEG) to evaluate for possible epilepsy, seizure disorders, or other neurological conditions. The procedure involves recording the patient's brain electrical activity while awake and asleep, including hyperventilation and photic stimulation when appropriate. The EEG is performed by a neurology or psychiatry physician, and the results are interpreted to assist in diagnosis and management.
Coding Specifications
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Modifiers:
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26: Used when reporting only the professional component (interpretation and report) of the EEG procedure. - Modifier
TC: Used when reporting only the technical component (equipment, technician, and supplies) of the EEG procedure. - Modifier
52: Used when the service is performed but reduced in scope (e.g., incomplete recording).
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Provider Taxonomies:
Taxonomy Code Specialty Name