Billing code 95868: Needle EMGMedicare rate & RVUs

Medicare pays $129.26 for 95868 nationally in the office. Local office rates run $115.76–$171.83.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 95868 covers

A clinician inserts a fine needle electrode into selected muscles supplied by cranial nerves and records electrical activity at rest and during activation. Neurologists and physiatrists commonly perform the study when evaluating problems such as facial weakness or suspected cranial nerve-related muscle dysfunction. The examination covers muscles on both sides; it is not limited to a single facial muscle or side.

Report this code when the documented needle examination involves bilateral cranial nerve–supplied muscles. The record should identify the muscles examined and support the clinical reason for the study. Medicare recognizes professional and technical components: use modifier 26 for the interpretation, modifier TC for equipment and staff, or no component modifier when billing the global service. The code is priced as bilateral, so modifier 50 does not increase payment; do not report separate units simply to represent the two sides.

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 95868 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

95868 rates by state

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

How the 95868 rate is calculated

Each of 95868’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.

Payment rules and modifiers for 95868

The CMS indicators that decide how 95868 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

95868 compared with similar codes

How to choose

95867Needle EMG

Choose 95868 for bilateral cranial nerve–supplied muscle examination; 95867 describes a unilateral examination.

95865Laryngeal EMG

Use 95865 when the needle examination targets laryngeal muscles, not bilateral cranial nerve–supplied muscles generally.

95866Diaphragm EMG

Use 95866 for needle EMG of a hemidiaphragm; 95868 is for cranial nerve–supplied muscles on both sides.

95860Needle EMG

Code 95860 is for needle EMG of one extremity. Select 95868 when the examined muscles are cranial nerve–supplied and bilateral.

Codes related to 95868

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

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

Open CMS sourceHow we calculate rates