CPT code 95866: Diaphragm EMG, one side2026 Medicare rate & RVUs in Queens, NY
Needle EMG of one hemidiaphragm evaluates diaphragmatic motor-unit activity when weakness, phrenic nerve dysfunction, or unexplained respiratory muscle impairment is suspected.
In Queens, NY, Medicare pays $156.70 for 95866 in the office.
Check a contract rate as a % of Medicare · 95866 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Queens, NY compares for 95866
Across 109 of 109 payment localities, the office rate for 95866 runs from $122.23 in Arkansas to $181.47 in San Benito County, CA. Queens, NY pays $156.70. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Queens, NY · this page$156.70
- Manhattan, NY · New York$155.07−$1.63
- NYC suburbs and Long Island, NY · New York$158.05+$1.35
- Poughkeepsie and northern NYC suburbs, NY · New York$147.38−$9.32
- Rest of New York · New York$131.09−$25.61
- Los Angeles, CA · California$154.56−$2.14
- Washington, DC area · District of Columbia$155.37−$1.33
Other areas in New York first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Miami, FLFlorida | $142.68 | — |
| Chicago, ILIllinois | $139.19 | — |
| AlaskaAlaska | $162.00 | — |
| AlabamaAlabama | $123.82 | — |
| ArkansasArkansas | $122.23 | — |
| ArizonaArizona | $133.13 | — |
| Bakersfield, CACalifornia | $145.41 | — |
| Chico, CACalifornia | $145.20 | — |
| El Centro, CACalifornia | $145.21 | — |
| Fresno, CACalifornia | $145.20 | — |
| Hanford, CACalifornia | $145.20 | — |
| Madera, CACalifornia | $145.20 | — |
| Merced, CACalifornia | $145.20 | — |
| Modesto, CACalifornia | $145.20 | — |
| Napa, CACalifornia | $167.87 | — |
| Oxnard, CACalifornia | $153.87 | — |
| Redding, CACalifornia | $145.20 | — |
| Rest of CaliforniaCalifornia | $145.20 | — |
| Riverside, CACalifornia | $145.77 | — |
| Sacramento, CACalifornia | $152.27 | — |
| Salinas, CACalifornia | $151.69 | — |
| San Diego, CACalifornia | $155.13 | — |
| Marin County, CACalifornia | $177.72 | — |
| San Francisco, CACalifornia | $177.67 | — |
| San Benito County, CACalifornia | $181.47 | — |
| Santa Clara County, CACalifornia | $181.24 | — |
| San Luis Obispo, CACalifornia | $149.24 | — |
| Santa Cruz, CACalifornia | $156.54 | — |
| Santa Maria, CACalifornia | $152.22 | — |
| Santa Rosa, CACalifornia | $158.12 | — |
| Stockton, CACalifornia | $145.20 | — |
| Vallejo, CACalifornia | $167.79 | — |
| Visalia, CACalifornia | $145.20 | — |
| Yuba City, CACalifornia | $145.20 | — |
| ColoradoColorado | $142.41 | — |
| ConnecticutConnecticut | $144.67 | — |
| DelawareDelaware | $135.18 | — |
| Fort Lauderdale, FLFlorida | $138.85 | — |
| Rest of FloridaFlorida | $132.99 | — |
| Atlanta, GAGeorgia | $138.24 | — |
| Rest of GeorgiaGeorgia | $126.46 | — |
| Hawaii, Guam, HIHawaii | $148.43 | — |
| IowaIowa | $127.29 | — |
| IdahoIdaho | $127.89 | — |
| East St. Louis, ILIllinois | $130.46 | — |
| Rest of IllinoisIllinois | $129.05 | — |
| Suburban Chicago, ILIllinois | $140.38 | — |
| IndianaIndiana | $128.57 | — |
| KansasKansas | $126.44 | — |
| KentuckyKentucky | $125.72 | — |
| New Orleans, LALouisiana | $130.97 | — |
| Rest of LouisianaLouisiana | $125.41 | — |
| Metropolitan Boston, MAMassachusetts | $155.97 | — |
| Rest of MassachusettsMassachusetts | $141.56 | — |
| Baltimore area, MDMaryland | $144.17 | — |
| Rest of MarylandMaryland | $137.67 | — |
| Rest of MaineMaine | $128.14 | — |
| Southern Maine, MEMaine | $134.81 | — |
| Detroit, MIMichigan | $134.14 | — |
| Rest of MichiganMichigan | $128.33 | — |
| MinnesotaMinnesota | $137.82 | — |
| Metropolitan Kansas City, MOMissouri | $130.51 | — |
| Metropolitan St. Louis, MOMissouri | $131.77 | — |
| Rest of MissouriMissouri | $123.28 | — |
| MississippiMississippi | $122.79 | — |
| MontanaMontana | $136.27 | — |
| North CarolinaNorth Carolina | $129.38 | — |
| North DakotaNorth Dakota | $135.28 | — |
| NebraskaNebraska | $128.01 | — |
| New HampshireNew Hampshire | $139.92 | — |
| Northern New JerseyNew Jersey | $153.97 | — |
| Rest of New JerseyNew Jersey | $146.70 | — |
| New MexicoNew Mexico | $128.82 | — |
| NevadaNevada | $136.09 | — |
| OhioOhio | $128.12 | — |
| OklahomaOklahoma | $125.86 | — |
| Portland, OROregon | $146.92 | — |
| Rest of OregonOregon | $135.40 | — |
| Metropolitan Philadelphia, PAPennsylvania | $141.18 | — |
| Rest of PennsylvaniaPennsylvania | $128.49 | — |
| Puerto RicoPuerto Rico | $137.28 | — |
| Rhode IslandRhode Island | $139.97 | — |
| South CarolinaSouth Carolina | $128.89 | — |
| South DakotaSouth Dakota | $135.17 | — |
| TennesseeTennessee | $126.96 | — |
| Austin, TXTexas | $141.61 | — |
| Beaumont, TXTexas | $127.71 | — |
| Brazoria, TXTexas | $135.39 | — |
| Dallas, TXTexas | $136.03 | — |
| Fort Worth, TXTexas | $135.11 | — |
| Galveston, TXTexas | $135.66 | — |
| Houston, TXTexas | $136.57 | — |
| Rest of TexasTexas | $131.33 | — |
| UtahUtah | $130.47 | — |
| VirginiaVirginia | $134.19 | — |
| Virgin Islands, VIUnited States Virgin Islands | $137.28 | — |
| VermontVermont | $134.51 | — |
| Rest of WashingtonWashington | $141.38 | — |
| King County, WAWashington | $159.31 | — |
| WisconsinWisconsin | $131.18 | — |
| West VirginiaWest Virginia | $124.70 | — |
| WyomingWyoming | $135.84 | — |
95866 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$122.23
$163.33
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $162.00 | 1 |
| AL | $123.82 | 1 |
| AR | $122.23 | 1 |
| AZ | $133.13 | 1 |
| CA | $145.20–$181.47 | 29 |
| CO | $142.41 | 1 |
| CT | $144.67 | 1 |
| DC | $155.37 | 1 |
| DE | $135.18 | 1 |
| FL | $132.99–$142.68 | 3 |
| GA | $126.46–$138.24 | 2 |
| GU | $148.43 | 1 |
| HI | $148.43 | 1 |
| IA | $127.29 | 1 |
| ID | $127.89 | 1 |
| IL | $129.05–$140.38 | 4 |
| IN | $128.57 | 1 |
| KS | $126.44 | 1 |
| KY | $125.72 | 1 |
| LA | $125.41–$130.97 | 2 |
| MA | $141.56–$155.97 | 2 |
| MD | $137.67–$155.37 | 3 |
| ME | $128.14–$134.81 | 2 |
| MI | $128.33–$134.14 | 2 |
| MN | $137.82 | 1 |
| MO | $123.28–$131.77 | 3 |
| MS | $122.79 | 1 |
| MT | $136.27 | 1 |
| NC | $129.38 | 1 |
| ND | $135.28 | 1 |
| NE | $128.01 | 1 |
| NH | $139.92 | 1 |
| NJ | $146.70–$153.97 | 2 |
| NM | $128.82 | 1 |
| NV | $136.09 | 1 |
| NY | $131.09–$158.05 | 5 |
| OH | $128.12 | 1 |
| OK | $125.86 | 1 |
| OR | $135.40–$146.92 | 2 |
| PA | $128.49–$141.18 | 2 |
| PR | $137.28 | 1 |
| RI | $139.97 | 1 |
| SC | $128.89 | 1 |
| SD | $135.17 | 1 |
| TN | $126.96 | 1 |
| TX | $127.71–$141.61 | 8 |
| UT | $130.47 | 1 |
| VA | $134.19–$155.37 | 2 |
| VI | $137.28 | 1 |
| VT | $134.51 | 1 |
| WA | $141.38–$159.31 | 2 |
| WI | $131.18 | 1 |
| WV | $124.70 | 1 |
| WY | $135.84 | 1 |
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.
The exact Queens, NY inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,591
- Code
- 95866
- Physician work
- 1.22
- Practice expense
- 2.81
- Malpractice
- 0.05
GPCI2026.csv
81
- Locality
- Queens, NY
- Physician work
- 1.064
- Practice expense
- 1.182
- Malpractice
- 1.442
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.22 | × 1.064 | 1.2981 |
| Practice expense | 2.81 | × 1.182 | 3.3214 |
| Malpractice | 0.05 | × 1.442 | 0.0721 |
| Total RVUs | 4.6916 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Queens, NY$156.70
Office: (1.22 × 1.064 + 2.81 × 1.182 + 0.05 × 1.442) × $33.4009 = $156.70
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.
How 95866 has changed in Queens, NY
95866 · Office / nonfacility
$156.70
Effective 2026-10-01
The base rate is $11.16 higher than on 2025-10-01, moving from $145.54 to $156.70 (7.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$145.54changed to$156.70
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.25 changed to 1.22
- Practice expense RVU 2.59 changed to 2.81
- Work GPCI 1.065 changed to 1.064
- Practice expense GPCI 1.195 changed to 1.182
- Malpractice GPCI 1.462 changed to 1.442
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$141.11changed to$145.54
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.36 changed to 2.59
- Malpractice RVU 0.06 changed to 0.05
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$138.81changed to$141.11
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$150.29changed to$138.81
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.48 changed to 2.36
- Malpractice RVU 0.05 changed to 0.06
- Work GPCI 1.061 changed to 1.065
- Practice expense GPCI 1.212 changed to 1.195
- Malpractice GPCI 2.061 changed to 1.462
January 1, 2023
RVU23A
$160.78changed to$150.29
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 2.60 changed to 2.48
- Work GPCI 1.056 changed to 1.061
- Practice expense GPCI 1.228 changed to 1.212
- Malpractice GPCI 2.661 changed to 2.061
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$165.96changed to$160.78
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.69 changed to 2.60
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$163.13changed to$165.96
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.52 changed to 2.69
- Malpractice RVU 0.06 changed to 0.05
- Work GPCI 1.054 changed to 1.056
- Practice expense GPCI 1.214 changed to 1.228
- Malpractice GPCI 2.391 changed to 2.661
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$164.98changed to$163.13
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.56 changed to 2.52
- Malpractice RVU 0.09 changed to 0.06
- Work GPCI 1.052 changed to 1.054
- Practice expense GPCI 1.200 changed to 1.214
- Malpractice GPCI 2.121 changed to 2.391
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$160.78changed to$164.98
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.52 changed to 2.56
- Malpractice RVU 0.06 changed to 0.09
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$161.12changed to$160.78
- Conversion factor 35.8887 changed to 35.9996
- Malpractice RVU 0.07 changed to 0.06
- Malpractice GPCI 2.151 changed to 2.121
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$157.80changed to$161.12
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 2.47 changed to 2.52
- Malpractice RVU 0.06 changed to 0.07
- Practice expense GPCI 1.199 changed to 1.200
- Malpractice GPCI 2.181 changed to 2.151
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$157.51changed to$157.80
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 2.45 changed to 2.47
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$156.73changed to$157.51
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$153.76changed to$156.73
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 2.39 changed to 2.45
- Work GPCI 1.057 changed to 1.052
- Practice expense GPCI 1.197 changed to 1.199
- Malpractice GPCI 1.836 changed to 2.181
Held through RVU15B.
January 1, 2014
RVU14A
$161.64changed to$153.76
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 2.79 changed to 2.39
- Work GPCI 1.062 changed to 1.057
- Practice expense GPCI 1.195 changed to 1.197
- Malpractice GPCI 1.491 changed to 1.836
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $161.64
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $156.70 | Not available in this setting | RVU26D |
| 2026-07-01 | $156.70 | Not available in this setting | RVU26C |
| 2026-04-01 | $156.70 | Not available in this setting | RVU26B |
| 2026-01-01 | $156.70 | Not available in this setting | RVU26A |
| 2025-10-01 | $145.54 | Not available in this setting | RVU25D |
| 2025-07-01 | $145.54 | Not available in this setting | RVU25C |
| 2025-04-01 | $145.54 | Not available in this setting | RVU25B |
| 2025-01-01 | $145.54 | Not available in this setting | RVU25A |
| 2024-10-01 | $141.11 | Not available in this setting | RVU24D |
| 2024-07-01 | $141.11 | Not available in this setting | RVU24C |
| 2024-04-01 | $141.11 | Not available in this setting | RVU24B |
| 2024-03-09 | $141.11 | Not available in this setting | RVU24AR |
| 2024-01-01 | $138.81 | Not available in this setting | RVU24A |
| 2023-10-01 | $150.29 | Not available in this setting | RVU23D |
| 2023-07-01 | $150.29 | Not available in this setting | RVU23C |
| 2023-04-01 | $150.29 | Not available in this setting | RVU23B |
| 2023-01-01 | $150.29 | Not available in this setting | RVU23A |
| 2022-10-01 | $160.78 | Not available in this setting | RVU22D |
| 2022-07-01 | $160.78 | Not available in this setting | RVU22C |
| 2022-04-01 | $160.78 | Not available in this setting | RVU22B |
| 2022-01-01 | $160.78 | Not available in this setting | RVU22A |
| 2021-10-01 | $165.96 | Not available in this setting | RVU21D |
| 2021-07-01 | $165.96 | Not available in this setting | RVU21C |
| 2021-04-01 | $165.96 | Not available in this setting | RVU21B |
| 2021-01-01 | $165.96 | Not available in this setting | RVU21A |
| 2020-10-01 | $163.13 | Not available in this setting | RVU20D |
| 2020-07-01 | $163.13 | Not available in this setting | RVU20C |
| 2020-04-01 | $163.13 | Not available in this setting | RVU20B |
| 2020-01-01 | $163.13 | Not available in this setting | RVU20A |
| 2019-10-01 | $164.98 | Not available in this setting | RVU19D |
| 2019-07-01 | $164.98 | Not available in this setting | RVU19C |
| 2019-04-01 | $164.98 | Not available in this setting | RVU19B |
| 2019-01-01 | $164.98 | Not available in this setting | RVU19A |
| 2018-10-01 | $160.78 | Not available in this setting | RVU18D |
| 2018-07-01 | $160.78 | Not available in this setting | RVU18C |
| 2018-04-01 | $160.78 | Not available in this setting | RVU18B |
| 2018-01-01 | $160.78 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $161.12 | Not available in this setting | RVU17D |
| 2017-07-01 | $161.12 | Not available in this setting | RVU17C |
| 2017-04-01 | $161.12 | Not available in this setting | RVU17B |
| 2017-01-01 | $161.12 | Not available in this setting | RVU17A |
| 2016-10-01 | $157.80 | Not available in this setting | RVU16D |
| 2016-07-01 | $157.80 | Not available in this setting | RVU16C |
| 2016-04-01 | $157.80 | Not available in this setting | RVU16B |
| 2016-01-01 | $157.80 | Not available in this setting | RVU16A |
| 2015-10-01 | $157.51 | Not available in this setting | RVU15D |
| 2015-07-01 | $157.51 | Not available in this setting | RVU15C |
| 2015-04-01 | $156.73 | Not available in this setting | RVU15B |
| 2015-01-01 | $156.73 | Not available in this setting | RVU15A |
| 2014-10-01 | $153.76 | Not available in this setting | RVU14D |
| 2014-07-01 | $153.76 | Not available in this setting | RVU14C |
| 2014-04-01 | $153.76 | Not available in this setting | RVU14B |
| 2014-01-01 | $153.76 | Not available in this setting | RVU14A |
| 2013-10-01 | $161.64 | Not available in this setting | RVU13D |
| 2013-07-01 | $161.64 | Not available in this setting | RVU13C |
| 2013-04-01 | $161.64 | Not available in this setting | RVU13B |
| 2013-01-01 | $161.64 | Not available in this setting | RVU13AR |
Where the Queens, NY rate applies
Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.
- 95866 in New York · multiple payment areas
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
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 95866 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist