Billing code 95868: Needle EMGMedicare rate & RVUs in Delaware
Reports needle EMG of cranial nerve–supplied muscles on both sides, such as when evaluating facial weakness or other suspected cranial nerve dysfunction.
Medicare pays $128.18 for 95868 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 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.
95868 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $128.18 | Unavailable |
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.
How the rate is built · 95868
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.15Practice expense 2.66Malpractice 0.06
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 95868
The CMS indicators that decide how 95868 is paid alongside other services.
CMS payment indicators · 95868
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) | 2 | Already bilateral by definition: paid once at 100%. |
| 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
95868 without 26 · national office
$129.26
Needle EMG
95868-26 · Professional component
$61.79
Pays only the interpretation and report.
95868 compared with similar codes
Compare codes
95868 vs 95867 vs 95865 vs 95866 vs 95860: national Medicare rates
Swap in your local Medicare rate.
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.
95868 billing questions
How does this differ from 95867?
95868 represents examination of cranial nerve–supplied muscles on both sides. Use 95867 when the examination is unilateral.
Should modifier 50 be appended?
No. The code is already priced as bilateral, and modifier 50 does not increase payment.
When should modifier 26 or TC be used?
Use 26 for the professional interpretation and TC for the technical service, including equipment and staff. Bill without either modifier when reporting the global service.
What documentation supports reporting this code?
Document the cranial nerve–supplied muscles examined on both sides and the clinical indication, such as evaluation of facial weakness.
Is this the code for needle EMG of the larynx or diaphragm?
No. Code 95865 is for laryngeal needle EMG, and 95866 is for hemidiaphragm needle EMG; select based on the muscles examined.
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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