Billing code 95872: Needle EMGMedicare rate & RVUs in Delaware
Single-fiber needle EMG evaluates neuromuscular transmission and is reported when a specialized quantitative study is performed for suspected disorders such as myasthenia gravis.
Medicare pays $213.97 for 95872 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 95872 covers
Single-fiber needle EMG uses a specialized electrode and recording technique to assess variability in transmission between motor nerve and muscle fibers. Neurologists and physiatrists commonly perform it when a neuromuscular-junction disorder is suspected, including in an evaluation for myasthenia gravis. The examiner studies selected muscles; the service is distinguished by its technique, not by the number of extremities examined. It is performed in outpatient electrodiagnostic laboratories and hospital settings.
Report 95872 for the specialized single-fiber study, not for a conventional needle examination merely because a needle electrode is used. Documentation should identify the muscles examined, the single-fiber method and findings, and the clinical reason for testing. If routine needle EMG or nerve-conduction testing is also performed, document the distinct services and their findings. CMS recognizes professional and technical components: use modifier 26 for interpretation, TC for equipment and staff, or no component modifier for 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.
95872 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $213.97 | Unavailable |
How the 95872 rate is calculated
Each of 95872’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 · 95872
RVUs × geographic indexes × conversion factor
Work2.81
2.81 RVUs× 1.000 GPCI
Practice expense3.48
3.48 RVUs× 1.000 GPCI
Malpractice0.16
0.16 RVUs× 1.000 GPCI
Adjusted RVUs
6.4500
Conversion factor
$33.4009
Medicare rate
$215.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95872
The CMS indicators that decide how 95872 is paid alongside other services.
CMS payment indicators · 95872
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
95872 without 26 · national office
$215.44
Needle EMG
95872-26 · Professional component
$153.64
Pays only the interpretation and report.
95872 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 95860Needle EMG
- Use 95872 for the specialized single-fiber examination of neuromuscular transmission. Use 95860 for conventional needle EMG when the examination covers one extremity.
- 95870Needle EMG
- 95870 describes a limited conventional needle EMG. It is not selected simply because only a small area is examined; 95872 is distinguished by the single-fiber technique.
- 95885Needle EMG
- 95885 is limited conventional muscle testing performed with nerve-conduction testing. Choose 95872 when the documented muscle study uses the single-fiber method.
95872 billing questions
How does 95872 differ from routine needle EMG codes such as 95860 or 95870?
95872 identifies the specialized single-fiber recording technique used to assess neuromuscular transmission. Codes 95860 and 95870 describe conventional needle EMG based on the examination’s extent.
Can 95872 be reported with routine needle EMG or nerve-conduction testing?
It may be reported alongside other electrodiagnostic services when those services are separately performed and documented. The record should support the single-fiber study as distinct from the routine needle examination or nerve-conduction testing.
Which modifiers identify the components?
Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service, including equipment and staff. Report without a component modifier for the global service.
What documentation supports reporting 95872?
Document the clinical indication, muscles examined, use of the single-fiber technique, and study findings. The record should make clear why this specialized examination was performed.
Is the number of muscles or extremities the basis for choosing 95872?
No. The defining feature is the single-fiber method, rather than the extremity count used to distinguish conventional needle EMG codes.
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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