CPT 95865 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 | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital 15 - Mobile Unit |
| Common Modifiers | 26 - Professional component None XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95865 |
National average reimbursement for CPT 95865 by major payers:
$171.80
$179.75
$214.32
$236.32
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 95865 | $87.66 | 1881937928 - ALEXANDRA AARONSON | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 95865 | $266.02 | 1104046630 - SYED WALIUDDIN | 262522053 - (IL) VALLEY PSYCHIATRY AND COUNSELING LLC | IL | Psychiatry Physician (2084P0800X) |
United | 95865 | $129.71 | 1306340880 - GEORGE GIANAKAKOS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95865 | $37.87 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 95865 | $142.19 | 1962431726 - MARTINS ADEOYE | 432081789 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95865 | $74.47 | 1528695681 - MAYA CLOYD | 351913875 - INDIANA UNIVERSITY HEALTH SOUTHERN INDIANA PHYSICIANS | IL | Psychiatry Physician (2084P0800X) |
United | 95865 | $109.19 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 95865 | $176.86 | 1255534483 - SHALINI CHAWLA | 274089658 - (IL) SHALINI CHAWLA MD LLC | IL | Psychiatry Physician (2084P0800X) |
United | 95865 | $47.28 | 1033320049 - ANN STECK | 344428256 - TOLEDO HOSPITAL | OH | Family Medicine Physician (207Q00000X) |
United | 95865 | $135.00 | 1174859284 - MATTHEW NIEDZWIECKI | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 95865 | $86.58 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 95865 | $95.20 | 1285834440 - LARON PHILLIPS | 842494027 - BRIGHTSIDE MEDICAL | MS | Psychiatry Physician (2084P0800X) |
United | 95865 | $245.38 | 1548279870 - VINOD ALLURI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 95865 | $176.86 | 1437298361 - ALIYA HAFEEZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95865 | $142.36 | 1992234611 - USHA APPALANENI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | 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 95865 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95865 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 95865 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 |
|---|---|---|
| 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. |
| 95865-CPT | Low | Test Nerve In Voice Box, This Test Inserts A Needle Electrode Into The Muscles Of The Voice Box. An Emg (Electromyography) Measures How Nerves And Muscles Interact. It Shows If And How A Nerve Instruction Reaches A Muscle And How That Muscle Responds. |
| 95866-CPT | Low | Test Nerve In Diaphragm, This Test Inserts A Needle Electrode Into The Muscles Of The Diaphragm. An Emg (Electromyography) Measures How Nerves And Muscles Interact. It Shows If And How A Nerve Instruction Reaches A Muscle And How That Muscle Responds. |
| 95867-CPT | Low | Nerve Test In Head Or Neck, This Test Inserts An Electrode Attached To A Needle Into Muscles Of The Face Head And Neck To Measure The Electrical Interaction Between Nerves And Muscles. It Shows If And How A Nerve Instruction Reaches A Muscle And How That Muscle Responds. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95865. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95865 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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