CPT code 95860: Needle EMG2026 Medicare rate & RVUs in Iowa
Reports a needle electromyography study of one arm or leg to evaluate suspected nerve or muscle dysfunction, with related paraspinal sampling when appropriate.
Medicare pays $111.21 for 95860 in the office in Iowa (Iowa). 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 95860 covers
A clinician inserts a small needle electrode into selected muscles and records their electrical activity at rest and during activation. Neurologists and physical medicine and rehabilitation physicians commonly perform and interpret this test in outpatient electrodiagnostic laboratories or hospital settings. It helps evaluate problems such as unexplained limb weakness, numbness, suspected nerve-root irritation, or focal nerve injury. The muscle selection follows the clinical question; related paraspinal muscles may also be examined.
Report this code for a study of one extremity. The number of muscles sampled does not change the extremity count; document the side, muscles tested, findings, and clinical reason for the study. CMS recognizes a professional component for interpretation and a technical component for equipment and staff: report modifier 26 or TC when billing only that component. Billing without a component 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.
95860 in Iowa
| Payment locality | Office | Facility |
|---|---|---|
| Iowa | $111.21 | Unavailable |
How the 95860 rate is calculated
Each of 95860’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 · 95860
RVUs × geographic indexes × conversion factor
Work0.94
0.94 RVUs× 1.000 GPCI
Practice expense2.59
2.59 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
3.5800
Conversion factor
$33.4009
Medicare rate
$119.58
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95860
The CMS indicators that decide how 95860 is paid alongside other services.
CMS payment indicators · 95860
Needle EMG
| 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
95860 without 26 · national office
$119.58
Needle EMG
95860-26 · Professional component
$51.44
Pays only the interpretation and report.
95860 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95861Needle EMG
- Use 95860 for one extremity and 95861 for two. The distinction is the number of extremities covered, not the number of muscles tested.
- 95870Needle EMG
- 95870 is for a limited needle EMG examination. 95860 represents testing of one extremity.
- 95885Needle EMG
- 95885 is the limited EMG format used with nerve conduction testing; 95860 represents the one-extremity format outside that combined-study distinction.
- 95886Needle EMG add-on
- 95886 is the complete EMG format used with nerve conduction testing. Choose it rather than 95860 when that combined-study format applies.
95860 billing questions
How is this different from 95861?
95860 represents needle EMG of one extremity; 95861 represents testing of two extremities. Select by the extremity coverage, not by the number of muscles sampled.
When would 95870 be a better fit?
95870 describes a limited needle EMG study rather than the one-extremity study represented by 95860. Choose based on the documented scope of the muscle examination.
How does this differ from 95885 or 95886?
95885 and 95886 describe needle EMG performed with nerve conduction testing, with the choice depending on the extent of the EMG examination. 95860 represents the one-extremity study when that combined-study coding distinction is not the applicable format.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the interpretation, and modifier TC identifies the equipment-and-staff portion. Without either modifier, the claim represents the global service.
What should the report document?
Document the extremity examined, muscles sampled, relevant findings at rest and with activation, and the clinical reason for testing. The record should support why the selected muscles addressed the suspected nerve or muscle problem.
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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