CPT code 95869: Needle EMG, thoracic paraspinal muscles2026 Medicare rate & RVUs in Texas
Reports needle EMG sampling of thoracic paraspinal muscles when evaluating suspected thoracic nerve-root or related neuromuscular abnormalities.
Medicare pays $87.73–$99.87 for 95869 in the office in Texas, from Beaumont, TX to Austin, TX. 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 95869 covers
This service uses a needle electrode to record electrical activity in thoracic paraspinal muscles, including assessment for abnormal spontaneous activity or changes with muscle activation. Neurologists and physical medicine and rehabilitation physicians commonly perform it in an electrodiagnostic laboratory or office setting when symptoms or examination findings raise concern for a thoracic nerve-root or neuromuscular problem. The code is specific to thoracic paraspinals and excludes T1 and T12; it is not the code for limb muscles or other axial muscles.
Choose the code based on the muscles tested, not simply the patient’s symptoms. The report should identify the thoracic muscles and levels sampled, findings, and clinical question. CMS recognizes professional and technical components: report modifier 26 for the interpretation, modifier TC for equipment and staff, or no modifier for the global service. The interpretation should support the professional component, while the technical record should support the testing resources billed.
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 95869 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$87.73 to $99.87
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $99.87 | Unavailable |
| Beaumont, TX | $87.73 | Unavailable |
| Brazoria, TX | $94.33 | Unavailable |
| Dallas, TX | $94.83 | Unavailable |
| Fort Worth, TX | $94.02 | Unavailable |
| Galveston, TX | $94.54 | Unavailable |
| Houston, TX | $95.09 | Unavailable |
| Rest of Texas | $90.90 | Unavailable |
How the 95869 rate is calculated
Each of 95869’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 · 95869
RVUs × geographic indexes × conversion factor
Work0.36
0.36 RVUs× 1.000 GPCI
Practice expense2.46
2.46 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
2.8500
Conversion factor
$33.4009
Medicare rate
$95.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95869
The CMS indicators that decide how 95869 is paid alongside other services.
CMS payment indicators · 95869
Needle EMG, thoracic paraspinal muscles
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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
95869 without 26 · national office
$95.19
Needle EMG, thoracic paraspinal muscles
95869-26 · Professional component
$19.71
Pays only the interpretation and report.
95869 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 95870Needle EMGLimited muscle study
- Use 95869 for thoracic paraspinals; 95870 covers limited testing of other axial or non-limb muscles.
- 95860Needle EMGOne extremity
- Use 95860 for needle EMG testing of one extremity. Code 95869 is for thoracic paraspinal muscles.
- 95887Needle EMGNon-extremity, with nerve conduction
- Code 95887 is for non-extremity muscle testing performed with nerve conduction testing; 95869 identifies thoracic paraspinal testing.
95869 billing questions
When should 95869 be selected instead of 95870?
Use 95869 for thoracic paraspinal muscle testing. Code 95870 is for limited testing of other axial or non-limb muscles.
Does this code cover cervical or lumbar paraspinal muscles?
No. It describes thoracic paraspinal testing and excludes T1 and T12.
How are the professional and technical services billed?
Use modifier 26 for the interpretation and modifier TC for the equipment and staff. Reporting without a modifier represents the global service.
What documentation supports 95869?
Document the thoracic paraspinal muscles and levels sampled, the electrodiagnostic findings, and the clinical reason for testing.
Is 95869 the code for a limb needle EMG?
No. It is specific to thoracic paraspinal muscles; limb needle EMG codes are selected according to the extremity coverage.
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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