CPT 95819: Electroencephalogram Recording During Awake and Asleep States
Medicare pays $336 and commercial payers pay $481 on average nationally for this procedure.
CPT code 95819 describes an electroencephalogram (EEG) diagnostic study in which the provider records brain electrical activity during both awake and asleep states; service type: diagnostic neurophysiology testing; typical site of service: hospital outpatient department, ambulatory EEG lab, or inpatient setting where awake and sleep recordings can be obtained.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
National averages place Medicare at $336.3 and BUCA (an average commercial benchmark) at $481.5, so BUCA’s mean exceeds Medicare by $145.2. This gap highlights a common commercial-to-Medicare premium for CPT 95819, with BUCA closer to higher commercial means like Blue Cross Blue Shield and Cigna than to Medicare’s average.
Looking at dispersion measured as P75 minus P25, Blue Cross Blue Shield has a range of $187.7 (from $376.8 to $655.5), BUCA’s interquartile range is $364.2 (from $265.2 to $616.4), and UnitedHealth Group’s IQR is $505.7 (from $131.5 to $618.2). The tightest IQRs are Aetna at $352.2 and Cigna at $520.0; the widest IQR is UnitedHealth Group at $505.7, indicating substantial variability across major commercial payers versus Medicare’s narrower documented percentiles.