2025 CPT code 95816
(Active) Effective Date: N/A Medicine - Neurology and Neuromuscular Procedures Feed
Electroencephalogram (EEG); including recording awake and drowsy.
Modifiers 26 (Professional Component) and TC (Technical Component) are applicable when appropriate.
Medical necessity for 95816 is established when there is a clinical suspicion of a neurological condition affecting brain activity, such as seizures, sleep disorders, or other brain abnormalities. The documentation should clearly support the need for the EEG based on the patient's symptoms and clinical history.
The physician performs the EEG by placing electrodes on the patient's scalp to measure electrical activity. This procedure helps diagnose conditions like epilepsy, sleep disorders, and other brain disorders by analyzing brain wave patterns during awake and drowsy states.
In simple words: This is a routine brain wave test (EEG) done while you're awake and then getting drowsy. It helps doctors see how your brain works in different alertness levels.
This code represents a routine electroencephalogram (EEG) performed while the patient is awake and drowsy. It includes hyperventilation and/or photic stimulation when clinically appropriate and involves 20 to 40 minutes of recording time. This test assesses the brain's electrical activity in different states of alertness.
Example 1: A patient experiences episodes of confusion and memory loss. A routine EEG (95816) is ordered to rule out seizure activity or other neurological conditions., A patient with a known seizure disorder undergoes a routine EEG (95816) to monitor changes in brain activity and adjust medication as needed., A patient with excessive daytime sleepiness undergoes an EEG including awake and drowsy states (95816) to evaluate brain activity patterns and differentiate between sleep disorders and other neurological issues.
Documentation should include the reason for the EEG, the patient's history and clinical presentation, the duration of the recording, any provocations used (hyperventilation, photic stimulation), and the interpretation of the results.
- Revenue Code: T2D (OTHER TESTS - OTHER)
- Payment Status: Active
- Modifier TC rule: Modifier TC is applicable when only the technical component of the service is provided.
- Specialties:Neurology, Sleep Medicine
- Place of Service:Office, Hospital Outpatient, Independent Clinic