CPT 95928 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 95928 by major payers:
$268.60
$281.25
$349.68
$384.67
| 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 95928 | ||||||
United | 95928 | $191.97 | 1225211600 - JOHN MILLICHAP | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95928 | $561.40 | 1225211600 - JOHN MILLICHAP | 260899565 - MERCY SPECIALTY CLINIC | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95928 | $230.72 | 1407023674 - THEODOTE PONTIKES | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95928 | $112.80 | 1265698914 - NIMISHA PATEL | 363383867 | IL | Psychiatry Physician (2084P0800X) |
United | 95928 | $237.52 | 1265753867 - ASIFA CHOUDHRY | 850703768 - (IL) CARLE WEST PHYSICIAN GROUP INC | IL | Psychiatry Physician (2084P0800X) |
United | 95928 | $356.30 | 1366641714 - KHATIJA VAID | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 95928 | $509.42 | 1295791812 - LEON EPSTEIN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95928 | $375.60 | 1194974600 - GAURAV YADAVA | 363878197 - (IL) RITA YADAVA MDSC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95928 | $217.58 | 1508139262 - ALESSANDRA TACHAUER | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 95928 | $120.94 | 1902907116 - KHONDAKAR HASANAT | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 95928 | $300.17 | 1841721925 - CHELSEA CURRY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95928 | $433.14 | 1700099025 - EDWIN MERESH | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95928 | $388.13 | 1578531950 - DAVID RITACCO | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95928 | $157.00 | 1447365440 - AYAME TAKAHASHI | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95928 | $102.87 | 1053570754 - CHRISTOPHER HOLDEN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | 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 95928 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95928 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 95928 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 |
|---|---|---|
| 95925-CPT | Moderate | Short-Latency Somatosensory Evoked Potential Study, Stimulation Of Any/All Peripheral Nerves Or Skin Sites, Recording From The Central Nervous System; In Upper Limbs |
| 95926-CPT | Low | Short-Latency Somatosensory Evoked Potential Study, Stimulation Of Any/All Peripheral Nerves Or Skin Sites, Recording From The Central Nervous System; In Lower Limbs |
| 95928-CPT | Moderate | Central Motor Evoked Potential Study (Transcranial Motor Stimulation); Upper Limbs |
| 95929-CPT | Moderate | Central Motor Evoked Potential Study (Transcranial Motor Stimulation); Lower Limbs |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95928. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95928 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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