$80.43–$89.93
Use 95869 for thoracic paraspinals; 95870 covers limited testing of other axial or non-limb muscles.
On this page
CMS RVU26D · Effective 2026-10-01
95869 Needle EMG Medicare reimbursement rates in Pennsylvania
Reports needle EMG sampling of thoracic paraspinal muscles when evaluating suspected thoracic nerve-root or related neuromuscular abnormalities. Compare 95869 office and facility rates across CMS payment localities in Pennsylvania.
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 95869 in Pennsylvania?
Pennsylvania 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
$88.40–$98.97
2 of 2 localities have a supported rate.
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.
Electrodiagnostic testing
About 95869: Thoracic paraspinal needle EMG
Reports needle EMG sampling of thoracic paraspinal muscles when evaluating suspected thoracic nerve-root or related neuromuscular abnormalities.
This service uses a needle electrode to record electrical activity in thoracic paraspinal muscles, including assessment for abnormal spontaneous activity or changes with muscle activation. Neurologists and physical medicine and rehabilitation physicians commonly perform it in an electrodiagnostic laboratory or office setting when symptoms or examination findings raise concern for a thoracic nerve-root or neuromuscular problem. The code is specific to thoracic paraspinals and excludes T1 and T12; it is not the code for limb muscles or other axial muscles.
Choose the code based on the muscles tested, not simply the patient’s symptoms. The report should identify the thoracic muscles and levels sampled, findings, and clinical question. CMS recognizes professional and technical components: report modifier 26 for the interpretation, modifier TC for equipment and staff, or no modifier for the global service. The interpretation should support the professional component, while the technical record should support the testing resources billed.
CMS billing rules for 95869
- 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.
Where the value comes from
- Work RVU0.36 · 13%
- Practice expense (office) RVU2.46 · 86%
- Malpractice RVU0.03 · 1%
405
Medicare services in 2024 · #3731 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.
95869 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$112.39–$124.01
Use 95860 for needle EMG testing of one extremity. Code 95869 is for thoracic paraspinal muscles.
$82.86–$91.42
Code 95887 is for non-extremity muscle testing performed with nerve conduction testing; 95869 identifies thoracic paraspinal testing.
Compare 95869 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
Metropolitan Philadelphia →
Office / nonfacility
$98.97
Facility
Unavailable
Rest Of Pennsylvania →
Office / nonfacility
$88.40
Facility
Unavailable
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95869 billing questions
When should 95869 be selected instead of 95870?
Use 95869 for thoracic paraspinal muscle testing. Code 95870 is for limited testing of other axial or non-limb muscles.
Does this code cover cervical or lumbar paraspinal muscles?
No. It describes thoracic paraspinal testing and excludes T1 and T12.
How are the professional and technical services billed?
Use modifier 26 for the interpretation and modifier TC for the equipment and staff. Reporting without a modifier represents the global service.
What documentation supports 95869?
Document the thoracic paraspinal muscles and levels sampled, the electrodiagnostic findings, and the clinical reason for testing.
Is 95869 the code for a limb needle EMG?
No. It is specific to thoracic paraspinal muscles; limb needle EMG codes are selected according to the extremity coverage.
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.
12,59795868,,Ndl emg cranial nrv musc bi,A,,1.15,2.66,,2.66,NA,0.06,3.87,3.87,1,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,59895868,26,Ndl emg cranial nrv musc bi,A,,1.15,0.65,,0.65,,0.05,1.85,1.85,1,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,59995868,TC,Ndl emg cranial nrv musc bi,A,,0.00,2.01,,2.01,NA,0.01,2.02,2.02,1,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,6A,0,99,0.00,0.00,0.00
12,60095869,,Ndl emg thrc paraspinal musc,A,,0.36,2.46,,2.46,NA,0.03,2.85,2.85,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,60195869,26,Ndl emg thrc paraspinal musc,A,,0.36,0.21,,0.21,,0.02,0.59,0.59,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,60295869,TC,Ndl emg thrc paraspinal musc,A,,0.00,2.25,,2.25,NA,0.01,2.26,2.26,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,6A,0,99,0.00,0.00,0.00
12,60395870,,Ndl emg lmtd std musc 1 xtr,A,,0.36,2.20,,2.20,NA,0.03,2.59,2.59,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00