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See a sample rate comparisonCPT 95869 Fee Schedule
Last Verified: October 2026
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.
Test Nerve In The Spine, This Test Inserts A Needle Electrode Into The Primary Group Of Spinal Muscles Around The Torso. An Emg Measures How Nerves And Muscles Interact. It Shows If And How A Nerve Instruction Reaches A Muscle And How That Muscle Responds.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Neurology and Neuromuscular Procedures |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component XS - Separate Structure |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95869 |
| Medicaid Fee Schedule | View Medicaid rates for 95869 |
National average reimbursement for CPT 95869 by major payers:
$104.56
$100.88
$110.87
$134.83
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CPT 95869
5 of 25 sample ratesHigher to lower in this preview
Tracy Binius
$221.19Published rateNathan Ontrop
Advocate Health And Hospitals Corporation
$165.86Published rateChristopher Raio
St Joseph Hospital
$133.75Published rateDouglas Nordli
Saint Anthony Health Affiliates
$75.58Published rateTamar Caceres
$34.70Published rate
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See a sample payer proposalCPT 95869 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95869 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 95869 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 |
|---|---|---|
| 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. |
| 95869-CPT | Low | Test Nerve In The Spine, This Test Inserts A Needle Electrode Into The Primary Group Of Spinal Muscles Around The Torso. An Emg Measures How Nerves And Muscles Interact. 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 95869. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95869 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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