$48.50–$52.26
Both apply to spinal cord or peripheral nerve stimulator programming. Choose 95972 for complex programming, generally when more than three parameters are changed; choose 95971 for the simpler level.
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CMS RVU26D · Effective 2026-10-01
95972 Stimulator programming Medicare reimbursement rates in Pennsylvania
Reports complex programming of an implanted spinal cord or peripheral nerve stimulator when a clinician adjusts multiple device settings to manage stimulation. Compare 95972 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 95972 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
$57.14–$61.98
2 of 2 localities have a supported rate.
Facility setting
$34.45–$36.25
2 of 2 localities have a 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.
Neuromodulation programming
About 95972: Complex spinal or peripheral stimulator programming
Reports complex programming of an implanted spinal cord or peripheral nerve stimulator when a clinician adjusts multiple device settings to manage stimulation.
A clinician analyzes and reprograms an implanted spinal cord or peripheral nerve stimulator, often during follow-up for chronic pain when stimulation coverage, symptom control, or treatment tolerance needs adjustment. Programming may involve changing settings such as electrode selection, amplitude, pulse width, frequency, or cycling. Pain specialists, neurologists, neurosurgeons, and other qualified clinicians may perform the service in an office or facility setting.
Choose 95972 for complex programming of a spinal cord or peripheral nerve system, generally when more than three parameters are changed; use the simpler level when fewer parameters are adjusted. Document the device and anatomic system, the clinical reason for programming, settings assessed and changed, and the patient’s response. CMS values the reported service under the physician fee schedule, with applicable rates shown separately on FeeBase.
Where the value comes from
- Work RVU0.80 · 45%
- Practice expense (office) RVU0.92 · 51%
- Malpractice RVU0.07 · 4%
35.4K
Medicare services in 2024 · #918 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.
95972 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$19.08–$20.40
95970 covers analysis without reprogramming. Use 95972 when the clinician changes settings as part of complex programming.
$49.28–$52.53
95977 is the complex programming level for a cranial nerve stimulator. 95972 is for spinal cord or peripheral nerve systems.
Compare 95972 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
$61.98
Facility
$36.25
Rest Of Pennsylvania →
Office / nonfacility
$57.14
Facility
$34.45
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95972 billing questions
How does 95972 differ from 95971?
Both cover programming of spinal cord or peripheral nerve stimulators. Report 95972 for complex programming, generally involving changes to more than three parameters; 95971 is the simpler level.
Can 95972 be reported when settings are only checked?
No. 95972 describes programming, so settings must be changed. For analysis without reprogramming, consider 95970.
Is 95972 used for cranial nerve stimulators?
No. It is for spinal cord or peripheral nerve systems. Cranial nerve stimulator programming is represented by the separate 95976 and 95977 levels.
How many units should be reported for a programming session?
Report one unit for the complex programming service, not a separate unit for each parameter changed.
What documentation supports complex programming?
Record the implanted system and site, the reason for adjustment, the settings evaluated and changed, and the patient’s response. The record should support the complex level selected.
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.
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12,72895976,,Alys smpl cn npgt prgrmg,A,,0.71,0.37,,0.18,,0.06,1.14,0.95,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,72995977,,Alys cplx cn npgt prgrmg,A,,0.95,0.49,,0.24,,0.08,1.52,1.27,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,73095980,,Io anal gast n-stim init,A,,0.78,0.27,NA,0.27,,0.19,1.24,1.24,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00