CPT 95872 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 • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 95872 by major payers:
$219.16
$237.64
$250.83
$299.89
| 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 95872 | ||||||
United | 95872 | $306.10 | 1063471159 - MARK WAINWRIGHT | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95872 | $386.02 | 1669524369 - JENNIFER KURTH | 205734385 | IL | Psychiatry Physician (2084P0800X) |
United | 95872 | $316.92 | 1932272952 - MOHAMMED HOMSI | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95872 | $245.66 | 1235440058 - CAROLYN DOYLE | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 95872 | $324.02 | 1144267865 - NITIN PATEL | 205521741 - SOUTHERN ILLINOIS MEDICAL SERVICES NFP | MO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95872 | $168.02 | 1932272952 - MOHAMMED HOMSI | 452353153 - (IL) HOMSI PEDIATRIC NEUROLOGY INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95872 | $89.08 | 1952460933 - LARISSA CHISM BUGGS | 810231784 - BILLINGS CLINIC | IN | Psychiatry Physician (2084P0800X) |
United | 95872 | $32.11 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 95872 | $357.64 | 1760419311 - PETER HEYDEMANN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95872 | $331.92 | 1568956043 - REID ALLEY | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 95872 | $334.38 | 1760907133 - ILLINOIS PROFESSIONALS HEALTH PROGRAM, LLC | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | IL | Psychiatry Physician (2084P0800X) |
United | 95872 | $386.02 | 1629335260 - DIVYA DESAI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95872 | $168.02 | 1760419311 - PETER HEYDEMANN | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95872 | $343.02 | 1356723811 - VICTOR PATRON ROMERO | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 95872 | $435.23 | 1063471159 - MARK WAINWRIGHT | 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 95872 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95872 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 95872 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 |
|---|---|---|
| 95870-CPT | Low | Needle Electromyography; Limited Study Of Muscles In 1 Extremity Or Non-Limb (Axial) Muscles (Unilateral Or Bilateral), Other Than Thoracic Paraspinal, Cranial Nerve Supplied Muscles, Or Sphincters |
| 95872-CPT | Moderate | Needle Electromyography Using Single Fiber Electrode, With Quantitative Measurement Of Jitter, Blocking And/Or Fiber Density, Any/All Sites Of Each Muscle Studied |
| 95873-CPT | Low | Electrical Stimulation For Guidance In Conjunction With Chemodenervation (List Separately In Addition To Code For Primary Procedure) |
| 95874-CPT | Low | Needle Electromyography For Guidance In Conjunction With Chemodenervation (List Separately In Addition To Code For Primary Procedure). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95872. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95872 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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