Needle electromyography of two extremities, including the related paraspinal muscles when they are sampled, performed without a same-day nerve conduction study.
- Medicare
- $161.99
- Work RVU
- 1.5
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Clinical reason for testing both limbs, such as bilateral numbness or a radiculopathy versus entrapment question
- Each muscle sampled, by limb, with insertional activity, spontaneous activity, and motor unit findings
- Muscle count per limb showing a complete study (generally five or more muscles across three nerves or four levels)
- Paraspinal levels sampled, if any, tied to the limbs tested
- Statement that no nerve conduction study was performed the same day
- Interpretation and impression signed by the physician who performed the needle exam
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
Two limbs, needle exam, no nerve conductions that day: that is 95861. Paraspinal muscles tied to those limbs are included, so you do not bill them separately. In an ortho practice this usually shows up as a bilateral upper extremity study for suspected cervical radiculopathy versus bilateral carpal tunnel, or both legs for a patient with lumbar stenosis and bilateral symptoms.
The biggest trap is the nerve conduction pairing. If nerve conduction studies (95907 to 95913) are done the same day, 95861 is the wrong code. The needle portion moves to the add-on codes 95885 or 95886, one per extremity. Billing 95861 next to an NCS code is a common NCCI denial.
A complete extremity study generally means at least five muscles per limb, supplied by three nerves or four spinal levels. If the report shows two or three muscles in one arm, the documentation does not support a complete two-limb study. Many Medicare contractors also cap the number of studies per diagnosis, so the referring diagnosis has to justify testing both sides.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (1.5) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.85) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.5 |
| Practice expense RVU | 3.27 |
| Malpractice RVU | 0.08 |
| Total RVU | 4.85 |
| Medicare national rate | $161.99 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $161.99 |
HOPD (APC 5734) Hospital outpatient department | $135.93 |
Common denial reasons
The recurring reasons claims for CPT 95861 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed with 95907 to 95913 on the same date instead of using 95885 or 95886
- Fewer muscles documented than a complete study requires
- Diagnosis supports only one symptomatic limb
- Exceeds the contractor's maximum studies per diagnosis
- Paraspinal muscles billed separately when already included
- Needle exam performed by a technician rather than the physician
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can 95861 be billed with a nerve conduction study?
02Are paraspinal muscles billed separately with 95861?
03How many muscles make a complete EMG of one extremity?
04Does 95861 have a professional and technical split?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records which limbs were symptomatic and why both needed testing, so the referral note supports a two-extremity study before the patient reaches the EMG lab.
See how Mira captures CPT 95861 documentation