CPT 95867 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 95867 by major payers:
$124.72
$122.63
$129.77
$161.37
| 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 95867 | ||||||
United | 95867 | $76.91 | 1043254980 - NISHANT SHAH | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95867 | $111.62 | 1831243831 - PAMELA VERGARA-RODRIGUEZ | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 95867 | $37.88 | 1982629051 - THOMAS HERRMANN | 363637465 - (IL) HOOPESTON COMMUNITY MEMORIAL HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 95867 | $81.93 | 1578531950 - DAVID RITACCO | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95867 | $351.38 | 1942475678 - DANIEL BATEMAN | 222519596 - DARTMOUTH-HITCHCOCK CLINIC | IL | Psychiatry Physician (2084P0800X) |
United | 95867 | $96.98 | 1992122410 - DIVAKAR MITHAL | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95867 | $220.39 | 1083979124 - RAHUL SHARMA | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95867 | $163.55 | 1033215868 - MOHAMMED ALI | 320552496 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95867 | $97.05 | 1932272952 - MOHAMMED HOMSI | 452353153 - (IL) HOMSI PEDIATRIC NEUROLOGY INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95867 | $220.33 | 1285715847 - SHANNON JENNINGS | 362604009 - (IL) OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER | MI | Psychiatry Physician (2084P0800X) |
United | 95867 | $185.39 | 1356723811 - VICTOR PATRON ROMERO | 911780074 | IL | Psychiatry Physician (2084P0800X) |
United | 95867 | $111.62 | 1023112745 - NELDA AKINBILE | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 95867 | $154.60 | 1225211600 - JOHN MILLICHAP | 454158203 - COMMUNITY CARE NETWORK INC | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95867 | $171.44 | 1215025309 - DEBORAH GARRELTS-DAOUD | 237076080 - (IL) CRUSADERS CENTRAL CLINIC ASSOCIATION | IA | Psychiatry Physician (2084P0800X) |
United | 95867 | $52.38 | 1972501252 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
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 95867 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95867 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 95867 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 | Needle Measurement And Recording Of Electrical Activity Of Muscles Of Arm Or Leg, 1 Extremity |
| 95865-CPT | Low | Needle Measurement And Recording Of Electrical Activity Of Muscles Of Voice Box |
| 95866-CPT | Low | Needle Measurement And Recording Of Electrical Activity Of Muscles Between Chest And Abdominal Cavit |
| 95867-CPT | Low | Needle Measurement And Recording Of Electrical Activity Of Cranial Nerve-Supplied Muscles On One Sid |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95867. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95867 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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