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CPT code 95866: Diaphragm EMG, one side2026 Medicare rate & RVUs in Puerto Rico

Needle EMG of one hemidiaphragm evaluates diaphragmatic motor-unit activity when weakness, phrenic nerve dysfunction, or unexplained respiratory muscle impairment is suspected.

CMS RVU26DEffective Oct 1, 2026One payment locality65 Medicare services in 2024

In Puerto Rico, Medicare pays $137.28 for 95866 in the office.

$137.28Office (non-facility)
Not available in this settingHospital or facility
+0.7%vs the national office rate ($136.28)

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.

We’ll open 95866 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 95866 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 Puerto Rico 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. Puerto Rico pays $137.28. The RVUs are the same everywhere; the geographic indexes change the dollars.

95866 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$137.28
  2. Los Angeles, CA · California$154.56+$17.28
  3. Washington, DC area · District of Columbia$155.37+$18.09
  4. Miami, FL · Florida$142.68+$5.40
  5. Chicago, IL · Illinois$139.19+$1.91
  6. Manhattan, NY · New York$155.07+$17.79
  7. Alaska · Alaska$162.00+$24.72

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

95866 in every other Medicare payment locality
Payment localityOfficeFacility
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—

95866 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
95866 office rate range by state
State / territoryOffice rate rangeLocalities
AK$162.001
AL$123.821
AR$122.231
AZ$133.131
CA$145.20–$181.4729
CO$142.411
CT$144.671
DC$155.371
DE$135.181
FL$132.99–$142.683
GA$126.46–$138.242
GU$148.431
HI$148.431
IA$127.291
ID$127.891
IL$129.05–$140.384
IN$128.571
KS$126.441
KY$125.721
LA$125.41–$130.972
MA$141.56–$155.972
MD$137.67–$155.373
ME$128.14–$134.812
MI$128.33–$134.142
MN$137.821
MO$123.28–$131.773
MS$122.791
MT$136.271
NC$129.381
ND$135.281
NE$128.011
NH$139.921
NJ$146.70–$153.972
NM$128.821
NV$136.091
NY$131.09–$158.055
OH$128.121
OK$125.861
OR$135.40–$146.922
PA$128.49–$141.182
PR$137.281
RI$139.971
SC$128.891
SD$135.171
TN$126.961
TX$127.71–$141.618
UT$130.471
VA$134.19–$155.372
VI$137.281
VT$134.511
WA$141.38–$159.312
WI$131.181
WV$124.701
WY$135.841

See 95866 in every payment locality

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

Office or facility?

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 95866 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.22× 1.0001.2200
Practice expense2.81× 1.0112.8409
Malpractice0.05× 0.9850.0493
Total RVUs4.1102
Conversion factor× 33.4009

Office rate, Puerto Rico$137.28

Office: (1.22 × 1 + 2.81 × 1.011 + 0.05 × 0.985) × $33.4009 = $137.28

Open 95866 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)3Each side paid at 100% (no 150% cap).
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical1Diagnostic 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.

When to use modifier 26

Codes related to 95866

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 95866
CodeHow it relatesOffice range, Puerto Rico
Same family
95865Laryngeal EMG, needle studyNeedle EMG in this family for laryngeal muscles rather than a hemidiaphragm.$154.70
95869Needle EMG, thoracic paraspinal musclesNeedle EMG in this family for thoracic paraspinal muscles.$96.08
95870Needle EMG, limited muscle studyLimited needle EMG of selected muscles, distinct from diaphragm examination.$87.30
95860Needle EMG, one extremityNeedle EMG in this family for muscles of one extremity.$120.50

How 95866 has changed in Puerto Rico

95866 · Office / nonfacility

$137.28

Effective 2026-10-01

The base rate is $10.89 higher than on 2025-10-01, moving from $126.39 to $137.28 (8.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $126.39changed to$137.28

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $122.68changed to$126.39

    • 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.

  3. March 9, 2024

    RVU24AR

    $120.68changed to$122.68

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $128.74changed to$120.68

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $128.09changed to$128.74

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $135.66changed to$128.09

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.60 changed to 2.48
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $139.95changed to$135.66

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.69 changed to 2.60

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $138.92changed to$139.95

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $141.17changed to$138.92

    • 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
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $138.49changed to$141.17

    • 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.

  11. January 1, 2018

    RVU18AR1

    $123.89changed to$138.49

    • Conversion factor 35.8887 changed to 35.9996
    • Malpractice RVU 0.07 changed to 0.06
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $107.73changed to$123.89

    • 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 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $107.61changed to$107.73

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.45 changed to 2.47

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $107.08changed to$107.61

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $104.61changed to$107.08

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.39 changed to 2.45
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $107.40changed to$104.61

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.79 changed to 2.39
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $107.40

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$137.28Not available in this settingRVU26D
2026-07-01$137.28Not available in this settingRVU26C
2026-04-01$137.28Not available in this settingRVU26B
2026-01-01$137.28Not available in this settingRVU26A
2025-10-01$126.39Not available in this settingRVU25D
2025-07-01$126.39Not available in this settingRVU25C
2025-04-01$126.39Not available in this settingRVU25B
2025-01-01$126.39Not available in this settingRVU25A
2024-10-01$122.68Not available in this settingRVU24D
2024-07-01$122.68Not available in this settingRVU24C
2024-04-01$122.68Not available in this settingRVU24B
2024-03-09$122.68Not available in this settingRVU24AR
2024-01-01$120.68Not available in this settingRVU24A
2023-10-01$128.74Not available in this settingRVU23D
2023-07-01$128.09Not available in this settingRVU23C
2023-04-01$128.09Not available in this settingRVU23B
2023-01-01$128.09Not available in this settingRVU23A
2022-10-01$135.66Not available in this settingRVU22D
2022-07-01$135.66Not available in this settingRVU22C
2022-04-01$135.66Not available in this settingRVU22B
2022-01-01$135.66Not available in this settingRVU22A
2021-10-01$139.95Not available in this settingRVU21D
2021-07-01$139.95Not available in this settingRVU21C
2021-04-01$139.95Not available in this settingRVU21B
2021-01-01$139.95Not available in this settingRVU21A
2020-10-01$138.92Not available in this settingRVU20D
2020-07-01$138.92Not available in this settingRVU20C
2020-04-01$138.92Not available in this settingRVU20B
2020-01-01$138.92Not available in this settingRVU20A
2019-10-01$141.17Not available in this settingRVU19D
2019-07-01$141.17Not available in this settingRVU19C
2019-04-01$141.17Not available in this settingRVU19B
2019-01-01$141.17Not available in this settingRVU19A
2018-10-01$138.49Not available in this settingRVU18D
2018-07-01$138.49Not available in this settingRVU18C
2018-04-01$138.49Not available in this settingRVU18B
2018-01-01$138.49Not available in this settingRVU18AR1
2017-10-01$123.89Not available in this settingRVU17D
2017-07-01$123.89Not available in this settingRVU17C
2017-04-01$123.89Not available in this settingRVU17B
2017-01-01$123.89Not available in this settingRVU17A
2016-10-01$107.73Not available in this settingRVU16D
2016-07-01$107.73Not available in this settingRVU16C
2016-04-01$107.73Not available in this settingRVU16B
2016-01-01$107.73Not available in this settingRVU16A
2015-10-01$107.61Not available in this settingRVU15D
2015-07-01$107.61Not available in this settingRVU15C
2015-04-01$107.08Not available in this settingRVU15B
2015-01-01$107.08Not available in this settingRVU15A
2014-10-01$104.61Not available in this settingRVU14D
2014-07-01$104.61Not available in this settingRVU14C
2014-04-01$104.61Not available in this settingRVU14B
2014-01-01$104.61Not available in this settingRVU14A
2013-10-01$107.40Not available in this settingRVU13D
2013-07-01$107.40Not available in this settingRVU13C
2013-04-01$107.40Not available in this settingRVU13B
2013-01-01$107.40Not available in this settingRVU13AR

Price 95866 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 95866PPRRVU2026_Oct_nonQPP.csv, line 12,591 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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