CPT 95816: Electroencephalogram, Awake and Drowsy States
Medicare pays $288 and commercial payers pay $440 on average nationally for this procedure.
CPT code 95816 describes an electroencephalogram (EEG) performed with recording during the patient’s awake and drowsy states; this diagnostic neurophysiology procedure is used to evaluate cerebral electrical activity and is typically provided as an outpatient or ambulatory service in an EEG laboratory or hospital neurodiagnostics unit.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
Nationally, Medicare’s mean of $288.10 sits below BUCA’s commercial average of $440.40, reflecting a roughly $152.30 gap between a public payer baseline and a large commercial aggregate. BUCA’s mean places it near the upper half of commercial payers, with its median-related percentile spread suggesting higher typical commercial reimbursement compared with Medicare’s central tendency.
Dispersion measured as P75 minus P25 highlights variation across payers: Blue Cross Blue Shield has a spread of $239.30, UnitedHealth Group $386.00, Cigna $412.80, Aetna $291.60, and BUCA $276.00; Medicare’s interquartile spread is $356.00. Cigna shows the widest IQR at $412.80, while Blue Cross Blue Shield is the tightest at $239.30, indicating the most and least concentrated commercial rate distributions respectively.