CPT 95857 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95857 |
| Medicaid Fee Schedule | View Medicaid rates for 95857 |
National average reimbursement for CPT 95857 by major payers:
$70.64
$66.32
$69.85
$49.97
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 95857 | $93.06 | 1477074060 - OLATOLA IYI-OJO | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 95857 | $35.81 | 1265883375 - JOCELYN LORENZO | 726000821 | LA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95857 | $54.43 | 1477997674 - OLGA KOZLOVA | 813062689 - (IL) ADULT AND PEDIATRIC NEUROLOGY | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95857 | $76.25 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 95857 | $106.26 | 1326465436 - MUSADDIQ TARIQ | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95857 | $116.05 | 1417900168 - SUNILA OCONNOR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95857 | $69.59 | 1679739395 - BETSY OSTRANDER | 810232122 - BENEFIS HOSPITALS INC | UT | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95857 | $66.22 | 1821081720 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 95857 | $101.73 | 1265883375 - JOCELYN LORENZO | 274026658 | LA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95857 | $114.09 | 1225211600 - JOHN MILLICHAP | 383852646 - OSF MULTI-SPECIALTY GROUP | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95857 | $40.16 | 1730214206 - KALYANI GAVINI | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95857 | $96.18 | 1366883555 - DAVID BANAYAN | 911780160 | TX | Psychiatry Physician (2084P0800X) |
United | 95857 | $138.07 | 1225211600 - JOHN MILLICHAP | 260899565 - MERCY SPECIALTY CLINIC | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95857 | $97.19 | 1700226206 - ALIESJE SORGELOOS | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95857 | $59.36 | 1396945671 - REGINA HALL-NGORIMA | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | 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 95857 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95857 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 95857 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 |
|---|---|---|
| 95709-CPT | Moderate | Eeg W O Vid Ea 12 26hr Intmt, Electroencephalogram Eeg Without Video Review Of Data Technical Description By Eeg Technologist Each Increment Of 12 26 Hours With Intermittent Monitoring And Maintenance |
| 95857-CPT | Low | Tensilon Test For Weak Muscles, This Test Helps Identify Myasthenia Gravis A Problem With Nerve Signals Reaching Muscles That Creates Involuntary Weakness. The Drug Tensilon Is Given Through An Iv While A Person Exercises. |
| 95860-CPT | Low | Test Nerve In Arm Leg Muscles, An Electromyography (Emg) Measures How Muscles Respond To Nerve Impulses. An Electrode Attached To A Needle Is Inserted Into One Extremity (Arm Leg Hand Foot Or Neck Muscles). Related Muscles Along The Spine May Be Tested As Well. |
| 95861-CPT | Low | Test Nerve In Arm Leg Muscles, An Electromyography (Emg) Measures How Muscles Respond To Nerve Impulses. An Electrode Attached To A Needle Is Inserted Into One Extremity (Arm Leg Hand Foot Or Neck Muscles). Related Muscles Along The Spine May Be Tested As Well. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95857. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95857 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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