CPT 95861 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 | • None • 26 - Professional component • XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95861 |
National average reimbursement for CPT 95861 by major payers:
$183.41
$200.10
$219.90
$251.56
| 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 95861 | ||||||
United | 95861 | $141.09 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 95861 | $133.77 | 1679968697 - JEREMIAH BREWER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 95861 | $332.73 | 1760412621 - RHONDA LAMPEN | 911352172 - MULTICARE HEALTH SYSTEM | VA | Psychiatry Physician (2084P0800X) |
United | 95861 | $219.67 | 1891921367 - KAVITA THAKKAR | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | PA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95861 | $158.57 | 1043252521 - DENIS ALTMAN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95861 | $287.80 | 1942650130 - MALIK NASSAN | 362679194 - (IL) HEAD & NECK AND COSMETIC SURGERY ASSOCIATES, LLC | MN | Psychiatry Physician (2084P0800X) |
United | 95861 | $258.63 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 95861 | $143.52 | 1376001701 - SAMANTHA PATEL | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $170.55 | 1700099025 - EDWIN MERESH | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $147.91 | 1003869553 - MALEEHA AHSAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $171.16 | 1417900168 - SUNILA OCONNOR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95861 | $141.41 | 1689787426 - KAREN SEVERSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 95861 | $197.02 | 1659714806 - RAVI RAMASAMY | 910564748 - SEATTLE CHILDRENS HOSPITAL | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95861 | $295.25 | 1760419311 - PETER HEYDEMANN | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95861 | $127.68 | 1740213347 - OLUSOLA AJILORE | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | 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 95861 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95861 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 95861 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 95861. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95861 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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