Billing code 51785: Sphincter EMGMedicare rate & RVUs in Ohio
Needle-electrode EMG evaluates anal or urethral sphincter muscle activity, often during a urodynamic workup for voiding dysfunction or incontinence.
Medicare pays $364.26 for 51785 in the office in Ohio (Ohio). 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 51785 covers
This study records electrical activity from the anal or urethral sphincter using a needle electrode. Urologists and other clinicians performing urodynamic or pelvic-floor evaluations may use it when investigating suspected sphincter dysfunction, neurogenic bladder, or urinary incontinence. The needle technique distinguishes this service from sphincter EMG performed without a needle electrode.
Report the study when the needle-electrode sphincter EMG is performed and documented; the record should identify the site studied and support that the EMG service was completed. It may be performed as part of a broader urodynamic evaluation, with other services reported when separately performed and documented. Medicare recognizes professional and technical components: modifier 26 identifies interpretation, modifier TC identifies equipment and staff, and no component modifier represents the global service. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
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.
51785 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $364.26 | Unavailable |
How the 51785 rate is calculated
Each of 51785’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 · 51785
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.49Practice expense 9.75Malpractice 0.51
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 51785
The CMS indicators that decide how 51785 is paid alongside other services.
CMS payment indicators · 51785
Sphincter EMG
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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
51785 without 26 · national office
$392.46
Sphincter EMG
51785-26 · Professional component
$93.52
Pays only the interpretation and report.
51785 compared with similar codes
Compare codes
51785 vs 51784 vs 51726 vs 51728 vs 51792: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 51784Sphincter EMG
- Choose 51785 for needle-electrode sphincter EMG and 51784 for the non-needle technique.
- 51726Cystometrogram
- 51726 measures bladder pressure during a complex cystometrogram; 51785 records electrical activity from the anal or urethral sphincter.
- 51728Urodynamic study
- 51728 includes cystometrogram and voiding-pressure evaluation. Report 51785 for the distinct needle-electrode sphincter EMG when performed.
- 51792Urinary reflex study
- 51792 is a urinary reflex study; 51785 records needle-electrode EMG activity in the anal or urethral sphincter.
51785 billing questions
How does 51785 differ from 51784?
51785 is the needle-electrode sphincter EMG. Use 51784 for sphincter EMG performed without a needle electrode.
Can 51785 be reported with a cystometrogram?
It may be reported with a cystometrogram when the sphincter EMG is separately performed and documented as part of the evaluation. The services are distinct: 51785 evaluates sphincter electrical activity, while cystometrogram codes assess bladder pressure and function.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and modifier TC for the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
How does Medicare pay when 51785 is performed with other procedures?
For multiple procedures performed in the same session, Medicare pays the highest-valued procedure in full and applies a 50% reduction to the others.
What documentation supports 51785?
Document the sphincter site examined, use of a needle electrode, and the EMG service performed. The record should distinguish this study from any separately reported urodynamic tests.
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
Fee sheets
Put 51785 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →