CPT 95869 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • XS - Separate Structure |
| Complexity Level | Low |
National average reimbursement for CPT 95869 by major payers:
$104.56
$100.88
$110.87
$138.02
| 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 95869 | ||||||
United | 95869 | $96.66 | 1972063501 - PALOMA REINOSO | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | NY | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95869 | $143.02 | 1689787426 - KAREN SEVERSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MT | Psychiatry Physician (2084P0800X) |
United | 95869 | $39.66 | 1730263617 - MARK ALTER | 910844563 | CA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95869 | $144.52 | 1952560492 - TAKIJAH HEARD | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95869 | $33.04 | 1326465436 - MUSADDIQ TARIQ | 510064318 - BAYHEALTH MEDICAL CENTER INC | IL | Psychiatry Physician (2084P0800X) |
United | 95869 | $126.19 | 1225211600 - JOHN MILLICHAP | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95869 | $139.36 | 1508922964 - COLLEEN BUHRFIEND | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95869 | $30.04 | 1710275110 - PRAVESH DEOTALE | 430654872 - ST LOUIS UNIVERSITY | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95869 | $143.02 | 1174859284 - MATTHEW NIEDZWIECKI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | RI | Psychiatry Physician (2084P0800X) |
United | 95869 | $111.70 | 1245217942 - WALTER WHANG | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 95869 | $504.54 | 1871912683 - LAUREN SCHUMACHER | 943281673 | CA | Psychiatry Physician (2084P0800X) |
United | 95869 | $195.13 | 1285712851 - MOHAMMAD IKRAMUDDIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95869 | $169.19 | 1285712851 - MOHAMMAD IKRAMUDDIN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95869 | $148.94 | 1730263617 - MARK ALTER | 910844563 | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95869 | $120.66 | 1326465436 - MUSADDIQ TARIQ | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | 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 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 |
|---|---|---|
| 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 |
| 95869-CPT | Low | Needle Measurement And Recording Of Electrical Activity Of Middle Spine Muscles |
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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