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CMS RVU26D · Effective 2026-10-01

95868 Needle EMG Medicare reimbursement rates in Georgia

Reports needle EMG of cranial nerve–supplied muscles on both sides, such as when evaluating facial weakness or other suspected cranial nerve dysfunction. Compare 95868 office and facility rates across CMS payment localities in Georgia.

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

What does Medicare pay for 95868 in Georgia?

Georgia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.

Office / nonfacility

$120.05–$131.20

2 of 2 localities have a supported rate.

Lowest: Rest Of Georgia

Highest: Atlanta

A spread of $11.15 per service.

Facility setting

No supported rate

These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.

Find 95868 in your payment locality →

Electrodiagnostic testing

About 95868: Bilateral cranial nerve muscle needle EMG

Reports needle EMG of cranial nerve–supplied muscles on both sides, such as when evaluating facial weakness or other suspected cranial nerve dysfunction.

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.

CMS billing rules for 95868

Professional and technical components
Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Bilateral procedures
The code is already priced as bilateral; modifier 50 does not increase payment.

Where the value comes from

  • Work RVU1.15 · 30%
  • Practice expense (office) RVU2.66 · 69%
  • Malpractice RVU0.06 · 2%

5.2K

Medicare services in 2024 · #1847 by national volume

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 compared with similar codes

Office rates for Georgia, from the same CMS release.

95867

Needle EMG

Cranial nerve muscles, one side

$98.82–$108.85

Choose 95868 for bilateral cranial nerve–supplied muscle examination; 95867 describes a unilateral examination.

95865

Laryngeal EMG

Needle study

$143.37–$155.93

Use 95865 when the needle examination targets laryngeal muscles, not bilateral cranial nerve–supplied muscles generally.

95866

Diaphragm EMG

One side

$126.46–$138.24

Use 95866 for needle EMG of a hemidiaphragm; 95868 is for cranial nerve–supplied muscles on both sides.

95860

Needle EMG

One extremity

$110.55–$121.39

Code 95860 is for needle EMG of one extremity. Select 95868 when the examined muscles are cranial nerve–supplied and bilateral.

Compare 95868 by payment locality

Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.

2 of 2 payment localities

Office and facility base rates · shared scale starting at $0

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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 95868PPRRVU2026_Oct_nonQPP.csv, line 12,597 (RVU26D)
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