CPT 95955 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Neurology and Neuromuscular Procedures |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 15 - Mobile Unit |
| Common Modifiers | • 26 - Professional component • None • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 95955 by major payers:
$224.43
$244.93
$324.07
$309.78
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 95955 | ||||||
United | 95955 | $107.19 | 1154749844 - NORA EKEANYA | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 95955 | $315.77 | 1134236565 - WARREN KAMMERER | 611549647 - (IL) WARREN KAMMERER MD SC | IL | Psychiatry Physician (2084P0800X) |
United | 95955 | $306.22 | 1730263617 - MARK ALTER | 910844563 | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95955 | $315.77 | 1013112333 - UTPAL DHRUVE | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95955 | $173.58 | 1508026972 - YANA OSKIN | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 95955 | $269.25 | 1265883375 - JOCELYN LORENZO | 274026658 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95955 | $283.83 | 1225211600 - JOHN MILLICHAP | 454158203 - COMMUNITY CARE NETWORK INC | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95955 | $72.37 | 1144267865 - NITIN PATEL | 431592082 - SGOH ACQUISITION INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95955 | $363.63 | 1518340231 - NAGA GUNTUPALLI | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 95955 | $212.63 | 1164410502 - ALAN FELTHOUS | 430654872 - ST LOUIS UNIVERSITY | IL | Psychiatry Physician (2084P0800X) |
United | 95955 | $306.22 | 1730263617 - MARK ALTER | 910844563 | MT | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95955 | $69.83 | 1255534483 - SHALINI CHAWLA | 274089658 - (IL) SHALINI CHAWLA MD LLC | IL | Psychiatry Physician (2084P0800X) |
United | 95955 | $96.65 | 1114472867 - MARCUS BYRD | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95955 | $82.09 | 1902907116 - KHONDAKAR HASANAT | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 95955 | $332.13 | 1568752665 - ANDREW KNOX | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 95955 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95955 code is part of the Medicine Services and Procedures services used for Neurology and Neuromuscular Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 95955 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 95940-CPT | Low | Continuous Intraoperative Neurophysiology Monitoring In The Operating Room One On One Monitoring Requiring Personal Attendance Each 15 Minutes (List Separately In Addition To Code For Primary Procedure) |
| 95954-CPT | Moderate | Pharmacological Or Physical Activation Requiring Physician Or Other Qualified Health Care Professional Attendance During Eeg Recording Of Activation Phase (Eg Thiopental Activation Test) (Revised 01/01/13) |
| 95955-CPT | Moderate | Eeg During Nonintracranial Surg.-Carotid |
| 95958-CPT | Moderate | Wada Activ Test Incl Eeg Monit |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95955. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95955 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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