CPT 95852 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 | • 11 - Office • 21 - Inpatient Hospital |
| Common Modifiers | • None • GO - Services delivered under an outpatient occupational therapy plan of care • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 95852 by major payers:
$20.41
$21.84
$21.33
$27.69
| 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 95852 | ||||||
United | 95852 | $18.79 | 1508139262 - ALESSANDRA TACHAUER | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 95852 | $38.72 | 1467802108 - MIRIAM BALTUANO SONGHURST | 863284696 - OU HEALTH PARTNERS INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95852 | $36.91 | 1881918415 - TUSHAR ADVANI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MT | Psychiatry Physician (2084P0800X) |
United | 95852 | $36.13 | 1730567900 - KHUSHBU SHAH | 364187449 | TN | Psychiatry Physician (2084P0800X) |
United | 95852 | $35.36 | 1952387318 - MELANY DANEHY | 911780074 | IL | Psychiatry Physician (2084P0800X) |
United | 95852 | $39.83 | 1104993161 - BETH LEDVORA | 463010946 - (IL) BETH LEDVORA M.D., S.C. | IL | Psychiatry Physician (2084P0800X) |
United | 95852 | $33.00 | 1295991701 - TRILOK SHAH | 465243116 - (IL) IN TOUCH PHYSICIANS LLC | IL | Psychiatry Physician (2084P0800X) |
United | 95852 | $29.63 | 1942330576 - NASIR SYED | 364132865 - (IL) PRIMARY HEALTHCARE ASSOCIATES SC | IL | Psychiatry Physician (2084P0800X) |
United | 95852 | $32.04 | 1225211600 - JOHN MILLICHAP | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95852 | $47.29 | 1437438249 - KAPIL AEDMA | 370661223 - METHODIST MEDICAL CENTER OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95852 | $32.84 | 1952569758 - CHARLES HEBERT | 911780160 | CO | Psychiatry Physician (2084P0800X) |
United | 95852 | $28.81 | 1962431726 - MARTINS ADEOYE | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95852 | $34.13 | 1245484740 - CHALONGCHAI PHITSANUWONG | 362177139 - UNIVERSITY OF CHICAGO | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95852 | $36.29 | 1174859284 - MATTHEW NIEDZWIECKI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95852 | $9.36 | 1699752204 - CATHERINE CAMILLERI | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
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 95852 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95852 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 95852 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 |
|---|---|---|
| 95851-CPT | Low | Range Of Motion Measurements And Report (Separate Procedure); Each Extremity (Excluding Hand) Or Each Trunk Section (Spine) |
| 95852-CPT | Low | Range Of Motion Measure/Report;Hand,W/Wo |
| 95860-CPT | Low | Needle Measurement And Recording Of Electrical Activity Of Muscles Of Arm Or Leg, 1 Extremity |
| 95861-CPT | Low | Needle Measurement And Recording Of Electrical Activity Of Muscles Of Arm(S) Or Leg(S), 2 Extremitie |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95852. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95852 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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