$157.62
Use 95866 for a hemidiaphragm examination and 95865 for laryngeal muscles; the target muscle site distinguishes the services.
On this page
CMS RVU26D · Effective 2026-10-01
95866 Diaphragm EMG Medicare reimbursement rates in Rhode Island
Needle EMG of one hemidiaphragm evaluates diaphragmatic motor-unit activity when weakness, phrenic nerve dysfunction, or unexplained respiratory muscle impairment is suspected. Compare 95866 office and facility rates across CMS payment localities in Rhode Island.
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 95866 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$139.97
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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 95866: Needle EMG of one hemidiaphragm
Needle EMG of one hemidiaphragm evaluates diaphragmatic motor-unit activity when weakness, phrenic nerve dysfunction, or unexplained respiratory muscle impairment is suspected.
This study records electrical activity and motor-unit behavior in one side of the diaphragm using a needle electrode. It may be used to evaluate suspected phrenic nerve injury, focal diaphragmatic weakness, or neuromuscular disease associated with respiratory impairment. Neurologists and physical medicine and rehabilitation physicians with electrodiagnostic expertise typically perform and interpret the examination, often during an evaluation of unexplained breathing difficulty or abnormal diaphragm motion.
Report the service for the hemidiaphragm examined, supported by documentation of the clinical indication, side studied, examination findings, and interpretation. When both sides are tested, CMS pays each side separately at 100%. The code has professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies the equipment and staff component, and reporting without either modifier represents the global service.
CMS billing rules for 95866
- 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
- Each side is paid separately at 100% when performed bilaterally.
Where the value comes from
- Work RVU1.22 · 30%
- Practice expense (office) RVU2.81 · 69%
- Malpractice RVU0.05 · 1%
65
Medicare services in 2024 · #5193 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.
95866 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$98.02
95869 describes needle EMG of thoracic paraspinal muscles, not the diaphragm.
$89.05
95870 is for a limited muscle examination. Choose 95866 when the diaphragm is the muscle site being examined.
$122.85
95860 covers needle EMG of one extremity; 95866 is specific to one side of the diaphragm.
Compare 95866 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
$139.97
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 95866 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
12,591
- Code
- 95866
- Physician work
- 1.22
- Practice expense
- 2.81
- Malpractice
- 0.05
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.22 | × 1.019 | 1.2432 |
| Practice expense | 2.81 | × 1.033 | 2.9027 |
| Malpractice | 0.05 | × 0.892 | 0.0446 |
| Total RVUs | 4.1905 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$139.97
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.22 | 1.019 |
| Practice expense | 2.81 | 1.033 |
| Malpractice | 0.05 | 0.892 |
(1.22 × 1.019 + 2.81 × 1.033 + 0.05 × 0.892) × $33.4009 = $139.97
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
95866 billing questions
How is bilateral diaphragm testing treated for payment?
CMS pays each side separately at 100% when both hemidiaphragms are examined. Document the side evaluated.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and modifier TC for the technical equipment and staff component. Without either modifier, the claim represents the global service.
How does 95866 differ from 95865?
95866 evaluates a hemidiaphragm; 95865 evaluates laryngeal muscles. Select the code for the muscle site examined.
How does 95866 differ from 95869?
95866 is for diaphragm examination, while 95869 is for thoracic paraspinal muscles. The documented muscles tested determine the choice.
What documentation supports reporting 95866?
Record the indication, the side examined, the needle examination findings, and the physician's interpretation.
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.
12,58895865,,Needle emg larynx,A,,1.53,2.99,,2.99,NA,0.08,4.60,4.60,1,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,58995865,26,Needle emg larynx,A,,1.53,0.89,,0.89,,0.07,2.49,2.49,1,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,59095865,TC,Needle emg larynx,A,,0.00,2.10,,2.10,NA,0.01,2.11,2.11,1,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,6A,0,99,0.00,0.00,0.00
12,59195866,,Needle emg hemidiaphragm,A,,1.22,2.81,,2.81,NA,0.05,4.08,4.08,1,XXX,0.00,0.00,0.00,0,3,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,59295866,26,Needle emg hemidiaphragm,A,,1.22,0.73,,0.73,,0.04,1.99,1.99,1,XXX,0.00,0.00,0.00,0,3,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,59395866,TC,Needle emg hemidiaphragm,A,,0.00,2.08,,2.08,NA,0.01,2.09,2.09,1,XXX,0.00,0.00,0.00,0,3,0,0,0,9,,33.4009,6A,0,99,0.00,0.00,0.00
12,59495867,,Ndl emg cranial nrv musc uni,A,,0.77,2.40,,2.40,NA,0.04,3.21,3.21,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537