Billing code 95869: Needle EMGMedicare rate & RVUs

Medicare pays $95.19 for 95869 nationally in the office. Local office rates run $83.12–$132.37.

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

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

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

109 of 109 payment localities

95869 rates by state

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

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.

Payment rules and modifiers for 95869

The CMS indicators that decide how 95869 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

95869 compared with similar codes

How to choose

95870Needle EMG

Use 95869 for thoracic paraspinals; 95870 covers limited testing of other axial or non-limb muscles.

95860Needle EMG

Use 95860 for needle EMG testing of one extremity. Code 95869 is for thoracic paraspinal muscles.

95887Needle EMG

Code 95887 is for non-extremity muscle testing performed with nerve conduction testing; 95869 identifies thoracic paraspinal testing.

Codes related to 95869

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