Billing code 95861: Needle EMGMedicare rate & RVUs in Delaware
Reports needle electromyography examining muscles in two extremities to evaluate suspected nerve, nerve-root, motor-neuron, or muscle disorders.
Medicare pays $160.66 for 95861 in the office in Delaware (Delaware). 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.
On this page 9 sections
What 95861 covers
A clinician inserts a fine needle electrode into selected muscles and records their electrical activity at rest and during voluntary activation. The findings can help evaluate problems such as suspected radiculopathy, peripheral nerve injury, or muscle disease. Neurologists and physical medicine and rehabilitation physicians commonly perform or interpret the study in office and hospital settings. The code identifies testing of two extremities; the specific muscles examined depend on the clinical question and examination plan.
Select the code based on the number of extremities examined, not the number of muscles sampled. Documentation should identify the extremities and muscles tested, the clinical reason for the study, and the findings and interpretation. CMS recognizes separately priced professional and technical components: modifier 26 represents interpretation, modifier TC represents equipment and staff, and reporting without a 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.
95861 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $160.66 | Unavailable |
How the 95861 rate is calculated
Each of 95861’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 · 95861
RVUs × geographic indexes × conversion factor
Work1.50
1.50 RVUs× 1.000 GPCI
Practice expense3.27
3.27 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
4.8500
Conversion factor
$33.4009
Medicare rate
$161.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95861
The CMS indicators that decide how 95861 is paid alongside other services.
CMS payment indicators · 95861
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
95861 without 26 · national office
$161.99
Needle EMG
95861-26 · Professional component
$81.16
Pays only the interpretation and report.
95861 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95860Needle EMG
- Use 95860 when one extremity is examined; 95861 represents two extremities. The number of muscles tested does not determine this distinction.
- 95863Needle EMG
- Use 95863 when three extremities are examined. For a study of two extremities, use 95861.
- 95885Needle EMG
- 95885 describes limited needle EMG by extremity when performed with nerve conduction studies. 95861 describes testing of two extremities rather than a limited study per extremity.
- 95886Needle EMG add-on
- 95886 describes complete needle EMG by extremity when performed with nerve conduction studies. 95861 identifies a two-extremity study.
95861 billing questions
How is 95861 distinguished from 95860 or 95863?
Choose by the number of extremities examined: 95860 is for one, 95861 for two, and 95863 for three. The count is based on extremities, not muscles sampled.
Which modifiers identify the components?
Use modifier 26 for the professional interpretation and modifier TC for the technical service, including equipment and staff. Without a modifier, the code represents the global service.
What should the record show to support two extremities?
Document the clinical indication, the two extremities examined, the muscles tested, and the study findings and interpretation.
Does sampling more muscles change the code to three extremities?
No. The code selection turns on the number of extremities examined, not the number of muscles sampled.
How does 95861 differ from 95885 and 95886?
95861 identifies a needle EMG study of two extremities. Codes 95885 and 95886 describe limited or complete needle EMG by extremity when performed with nerve conduction studies.
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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