CPT 95972 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 | Neurostimulators Analysis-Programming Procedures Neurology and Neuromuscular Procedures |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95972 |
National average reimbursement for CPT 95972 by major payers:
$74.22
$93.53
$97.14
$82.63
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 95972 | $71.43 | 1356386510 - POONAM DUGGAL | 203428877 - POONAM DUGGAL, M.D. | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $40.50 | 1699167999 - SANDY CADENA | 270600887 - (CA) UNIVERSAL COMMUNITY HEALTH CENTER | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $124.11 | 1518912526 - PETER STOOPS | 953930862 - (CA) HIGH DESERT MEDICAL CORPORATION | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $92.26 | 1922101237 - PAUL BAYARD | 941744108 - (CA) LA CLINICA DE LA RAZA INC | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $85.68 | 1003261496 - ANTONIO ROMAN | 540506332 - CARILION MEDICAL CENTER | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $43.74 | 1922325315 - EWA FARRELLY | 608056392 | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $107.44 | 1528366432 - SUN-LING CHEN | 421553807 - (CA) COMPREHENSIVE COMMUNITY HEALTH CENTERS INC | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $294.51 | 1689706327 - GERARDO MORENO | 954377219 | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $95.31 | 1104910629 - RUBEN CASABAR | 954372321 | CA | General Practice Physician (208D00000X) |
United | 95972 | $136.80 | 1639606130 - MATTHEW ROGERS | 951691313 - RADY CHILDRENS HOSPITAL-SAN DIEGO | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $150.08 | 1205936861 - JAMES LEONI | 862516661 - (CA) ATTENDA MEDICAL GROUP INC | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $124.11 | 1285668962 - DANIEL ROSE | 300684922 | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $213.22 | 1700839446 - FEOKTIST ORLOFF | 824780648 | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $259.16 | 1548873110 - GARRETT LONG | 954373071 | CA | Family Medicine Physician (207Q00000X) |
United | 95972 | $107.44 | 1740460658 - JENNIFER TRIF | 421553807 - (CA) COMPREHENSIVE COMMUNITY HEALTH CENTERS INC | CA | Family Medicine Physician (207Q00000X) |
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 95972 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95972 code is part of the Neurostimulators Analysis-Programming 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 95972 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 |
|---|---|---|
| 95961-CPT | Moderate | Electrode Stimulation Brain, Functional Cortical And Subcortical Mapping By Stimulation And Or Recording Of Electrodes On Brain Surface Or Of Depth Electrodes To Provoke Seizures Or Identify Vital Brain Structures Initial Hour Of Attendance By A Physician Or Other Qualified Health Care Professional |
| 95970-CPT | Low | Alys Npgt W O Prgrmg, Electronic Analysis Of Implanted Neurostimulator Pulse Generator Transmitter Eg Contact Group S Interleaving Amplitude Pulse Width Frequency Hz On Off Cycling Burst Magnet Mode Dose Lockout Patient Selectable Parameters Responsive Neurostimulation Detection Algorithms Closed Loop Parameters And Passive Parameters By Physician Or Other Qualified Health Care Professional With Brain Cranial Nerve Spinal Cord Peripheral Nerve Or Sacral Nerve Neurostimulator Pulse Generator Transmitter Without Programming |
| 95971-CPT | Low | Alys Smpl Sp Pn Npgt W Prgrm, Electronic Analysis Of Implanted Neurostimulator Pulse Generator Transmitter Eg Contact Group S Interleaving Amplitude Pulse Width Frequency Hz On Off Cycling Burst Magnet Mode Dose Lockout Patient Selectable Parameters Responsive Neurostimulation Detection Algorithms Closed Loop Parameters And Passive Parameters By Physician Or Other Qualified Health Care Professional With Simple Spinal Cord Or Peripheral Nerve Eg Sacral Nerve Neurostimulator Pulse Generator Transmitter Programming By Physician Or Other Qualified Health Care Professional |
| 95972-CPT | Low | Alys Cplx Sp Pn Npgt W Prgrm, Electronic Analysis Of Implanted Neurostimulator Pulse Generator Transmitter Eg Contact Group S Interleaving Amplitude Pulse Width Frequency Hz On Off Cycling Burst Magnet Mode Dose Lockout Patient Selectable Parameters Responsive Neurostimulation Detection Algorithms Closed Loop Parameters And Passive Parameters By Physician Or Other Qualified Health Care Professional With Complex Spinal Cord Or Peripheral Nerve Eg Sacral Nerve Neurostimulator Pulse Generator Transmitter Programming By Physician Or Other Qualified Health Care Professional |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95972. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95972 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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