CPT code 95866: Diaphragm EMG, one side2026 Medicare rate & RVUs in California
Needle EMG of one hemidiaphragm evaluates diaphragmatic motor-unit activity when weakness, phrenic nerve dysfunction, or unexplained respiratory muscle impairment is suspected.
Medicare pays $145.20–$181.47 for 95866 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 95866 covers
This study records electrical activity and motor-unit behavior in one side of the diaphragm using a needle electrode. It may be used to evaluate suspected phrenic nerve injury, focal diaphragmatic weakness, or neuromuscular disease associated with respiratory impairment. Neurologists and physical medicine and rehabilitation physicians with electrodiagnostic expertise typically perform and interpret the examination, often during an evaluation of unexplained breathing difficulty or abnormal diaphragm motion.
Report the service for the hemidiaphragm examined, supported by documentation of the clinical indication, side studied, examination findings, and interpretation. When both sides are tested, CMS pays each side separately at 100%. The code has professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies the equipment and staff component, and reporting without either modifier represents the global service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 95866 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$145.20 to $181.47
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $145.41 | Unavailable |
| Chico, CA | $145.20 | Unavailable |
| El Centro, CA | $145.21 | Unavailable |
| Fresno, CA | $145.20 | Unavailable |
| Hanford, CA | $145.20 | Unavailable |
| Los Angeles, CA | $154.56 | Unavailable |
| Madera, CA | $145.20 | Unavailable |
| Marin County, CA | $177.72 | Unavailable |
| Merced, CA | $145.20 | Unavailable |
| Modesto, CA | $145.20 | Unavailable |
| Napa, CA | $167.87 | Unavailable |
| Oxnard, CA | $153.87 | Unavailable |
| Redding, CA | $145.20 | Unavailable |
| Rest of California | $145.20 | Unavailable |
| Riverside, CA | $145.77 | Unavailable |
| Sacramento, CA | $152.27 | Unavailable |
| Salinas, CA | $151.69 | Unavailable |
| San Benito County, CA | $181.47 | Unavailable |
| San Diego, CA | $155.13 | Unavailable |
| San Francisco, CA | $177.67 | Unavailable |
| San Luis Obispo, CA | $149.24 | Unavailable |
| Santa Clara County, CA | $181.24 | Unavailable |
| Santa Cruz, CA | $156.54 | Unavailable |
| Santa Maria, CA | $152.22 | Unavailable |
| Santa Rosa, CA | $158.12 | Unavailable |
| Stockton, CA | $145.20 | Unavailable |
| Vallejo, CA | $167.79 | Unavailable |
| Visalia, CA | $145.20 | Unavailable |
| Yuba City, CA | $145.20 | Unavailable |
How the 95866 rate is calculated
Each of 95866’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 95866
RVUs × geographic indexes × conversion factor
Work1.22
1.22 RVUs× 1.000 GPCI
Practice expense2.81
2.81 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
4.0800
Conversion factor
$33.4009
Medicare rate
$136.28
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95866
The CMS indicators that decide how 95866 is paid alongside other services.
CMS payment indicators · 95866
Diaphragm EMG, one side
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 3 | Each side paid at 100% (no 150% cap). |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
95866 without 26 · national office
$136.28
Diaphragm EMG, one side
95866-26 · Professional component
$66.47
Pays only the interpretation and report.
95866 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95865Laryngeal EMGNeedle study
- Use 95866 for a hemidiaphragm examination and 95865 for laryngeal muscles; the target muscle site distinguishes the services.
- 95869Needle EMGThoracic paraspinal muscles
- 95869 describes needle EMG of thoracic paraspinal muscles, not the diaphragm.
- 95870Needle EMGLimited muscle study
- 95870 is for a limited muscle examination. Choose 95866 when the diaphragm is the muscle site being examined.
- 95860Needle EMGOne extremity
- 95860 covers needle EMG of one extremity; 95866 is specific to one side of the diaphragm.
95866 billing questions
How is bilateral diaphragm testing treated for payment?
CMS pays each side separately at 100% when both hemidiaphragms are examined. Document the side evaluated.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and modifier TC for the technical equipment and staff component. Without either modifier, the claim represents the global service.
How does 95866 differ from 95865?
95866 evaluates a hemidiaphragm; 95865 evaluates laryngeal muscles. Select the code for the muscle site examined.
How does 95866 differ from 95869?
95866 is for diaphragm examination, while 95869 is for thoracic paraspinal muscles. The documented muscles tested determine the choice.
What documentation supports reporting 95866?
Record the indication, the side examined, the needle examination findings, and the physician's interpretation.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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