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 |
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 | $164.25 | 1962664789 - JAMIE EVANS | 910844563 | MT | Psychiatry Physician (2084P0800X) |
United | 95861 | $220.47 | 1922481530 - THOMAS LOBUR | 362709982 - (IL) PRESENCE BEHAVIORAL HEALTH | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $163.35 | 1639673916 - BISHOY GOUBRAN | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $133.77 | 1679968697 - JEREMIAH BREWER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 95861 | $174.02 | 1710061486 - DAVID KEMP | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $331.89 | 1366890857 - STEVEN SHARP | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 95861 | $260.45 | 1407807746 - SYED KHAN | 320552496 | IN | Psychiatry Physician (2084P0800X) |
United | 95861 | $163.35 | 1972984169 - DAVID SHOLTES | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $161.33 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MN | Psychiatry Physician (2084P0800X) |
United | 95861 | $1068.76 | 1760502058 - P. DANIEL LE GRANGE | 943281657 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 | $174.53 | 1477997674 - OLGA KOZLOVA | 471293653 - GANESHA INSTITUTE OF NEUROLOGY AND PSYCHIATRY, S.C. | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95861 | $87.69 | 1164410502 - ALAN FELTHOUS | 201957741 | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $74.04 | 1932355591 - JONATHAN HOWARD | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 95861 | $284.42 | 1891921367 - KAVITA THAKKAR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | 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 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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