Billing code 95857: Cholinesterase challengeMedicare rate & RVUs
Reports a pharmacologic cholinesterase inhibitor challenge of an individual muscle, commonly used during evaluation of suspected myasthenia gravis.
Medicare pays $67.47 for 95857 nationally in the office and $23.71 in a hospital or facility. Local office rates run $59.95–$90.31.
Medicare rate · 95857
Cholinesterase challenge
Swap in your local Medicare rate.
- Work RVUs
- 0.52
- Total RVUs
- 2.02
- Global days
- XXX
National rate · 2026
$67.47
Office setting, before claim adjustments.
See every locality for 95857 → · Billed by an NP, PA or therapist? →
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 10 sections
What 95857 covers
This electrodiagnostic service assesses a selected muscle’s response to a cholinesterase inhibitor, such as edrophonium, by comparing its function before and after the challenge. Neurologists and other clinicians trained in electrodiagnostic testing may use it when evaluating fatigable weakness, ptosis, or diplopia suggestive of a neuromuscular junction disorder. The result is interpreted in the context of the patient’s examination and other diagnostic findings.
Report the service for each muscle tested, rather than for each drug dose or the overall visit. Documentation should identify the muscle, the pre- and post-challenge findings, and the clinical reason for testing. Medicare values the service under the Physician Fee Schedule using physician work, practice expense, and malpractice components; practice expense valuation differs between office and facility settings.
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 95857 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$59.95 to $90.31
109 of 109 payment localities
95857 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$59.95
$81.07
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 | $78.72 | 1 |
| AL | $60.79 | 1 |
| AR | $59.95 | 1 |
| AZ | $65.77 | 1 |
| CA | $71.83–$90.31 | 29 |
| CO | $70.51 | 1 |
| CT | $71.85 | 1 |
| DC | $77.24 | 1 |
| DE | $66.84 | 1 |
| FL | $66.00–$71.51 | 3 |
| GA | $62.46–$68.57 | 2 |
| GU | $73.59 | 1 |
| HI | $73.59 | 1 |
| IA | $62.52 | 1 |
| ID | $62.86 | 1 |
| IL | $63.98–$69.94 | 4 |
| IN | $63.22 | 1 |
| KS | $62.13 | 1 |
| KY | $61.94 | 1 |
| LA | $61.81–$64.77 | 2 |
| MA | $70.06–$77.50 | 2 |
| MD | $68.12–$77.24 | 3 |
| ME | $63.06–$66.54 | 2 |
| MI | $63.40–$66.68 | 2 |
| MN | $67.94 | 1 |
| MO | $60.71–$65.13 | 3 |
| MS | $60.34 | 1 |
| MT | $67.47 | 1 |
| NC | $63.72 | 1 |
| ND | $66.68 | 1 |
| NE | $62.88 | 1 |
| NH | $69.30 | 1 |
| NJ | $72.78–$76.46 | 2 |
| NM | $63.69 | 1 |
| NV | $67.30 | 1 |
| NY | $64.63–$78.94 | 5 |
| OH | $63.24 | 1 |
| OK | $61.95 | 1 |
| OR | $66.88–$72.82 | 2 |
| PA | $63.40–$70.04 | 2 |
| PR | $67.99 | 1 |
| RI | $69.26 | 1 |
| SC | $63.56 | 1 |
| SD | $66.58 | 1 |
| TN | $62.41 | 1 |
| TX | $62.99–$70.18 | 8 |
| UT | $64.41 | 1 |
| VA | $66.25–$77.24 | 2 |
| VI | $67.99 | 1 |
| VT | $66.32 | 1 |
| WA | $69.96–$79.16 | 2 |
| WI | $64.50 | 1 |
| WV | $61.66 | 1 |
| WY | $67.12 | 1 |
How the 95857 rate is calculated
Each of 95857’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 · 95857
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.52Practice expense 1.46Malpractice 0.04
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 95857
95857 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 95857
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$67.47
The facility rate would be $23.71 (+$43.76). In a facility, the facility bills its own costs separately.
95857 compared with similar codes
Compare codes
95857 vs 95937 vs 95872 vs 95860: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 95937NMJ testing
- Use 95857 for a cholinesterase inhibitor challenge of each muscle tested. Use 95937 for neuromuscular junction testing by electrical stimulation.
- 95872Needle EMG
- 95872 reports single-fiber EMG using a specialized electrode; 95857 reports the muscle’s response to a pharmacologic challenge.
- 95860Needle EMG
- 95860 reports needle EMG of one extremity. It evaluates electrical activity in muscles, rather than a cholinesterase inhibitor response.
95857 billing questions
How is 95857 different from repetitive nerve stimulation?
95857 reports a pharmacologic cholinesterase inhibitor challenge of each muscle tested. Repetitive nerve stimulation is an electrical neuromuscular junction test reported with 95937.
How many units should be reported?
Report by muscle tested, not by medication dose or visit. The record should identify each muscle challenged and its response.
What documentation supports the service?
Document the suspected neuromuscular junction problem, the muscle tested, and the findings before and after the challenge.
Can needle EMG be part of the same evaluation?
Yes. Needle EMG may be performed as a separate electrodiagnostic service when clinically indicated; document the muscles examined and findings for that service independently.
Is a cholinesterase challenge the same as single-fiber EMG?
No. The challenge evaluates a muscle’s response to a cholinesterase inhibitor, while single-fiber EMG evaluates electrical activity using a specialized electrode.
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
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