Surgical · General

Ischemic limb exercise test with serial specimen collection for muscle metabolite analysis

Verified May 8, 2026 · 6 sources ↓

Medicare: $128.59
Total RVUs: 3.85
Global, days
Region: General

Drawn from CMSAAPCNIHPayerpriceCgsmedicare

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Indication for testing: specific symptom complex (exercise-induced cramping, weakness, myoglobinuria) driving clinical suspicion of metabolic myopathy
Documentation of ischemic condition induction method and the exercise protocol used (e.g., forearm squeeze against resistance)
Serial specimen acquisition log: time points at which blood draws were obtained relative to exercise
Metabolite results reported: lactate and ammonia levels at each time point, with interpretation comparing expected vs. observed response
Ordering physician attestation or supervising physician presence per applicable incident-to or direct supervision rules
ICD-10 diagnosis code(s) supported by clinical presentation — medical necessity must be established in the note before the test is ordered

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

26 Professional component 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 95875 describes an ischemic limb exercise test in which the patient performs exercise under artificially induced ischemic conditions while serial blood specimens are drawn to measure muscle metabolites. The most common application is the ischemic forearm exercise test, used to diagnose McArdle disease (glycogen storage disease type V) and other metabolic myopathies by assessing whether lactate and ammonia rise appropriately after exercise. The test belongs to the ischemic muscle testing family under Neurology and Neuromuscular Procedures.

Orthopedic surgeons encounter this code when evaluating patients with exercise-induced myalgia, cramping, or weakness that cannot be explained by structural pathology. A positive result — failure of lactate to rise with normal ammonia rise — points to a glycogenolytic defect. A flat ammonia curve alongside flat lactate suggests a purine nucleotide cycle defect. These distinctions drive ICD-10 diagnosis coding and downstream metabolic specialist referrals.

Global period is XXX, meaning standard surgical global rules do not apply and the service is billed on the date performed without global bundling concerns. The code carries a facility-site payment under the HOPD fee schedule; there is no ASC payment rate assigned.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.07
Practice expense RVU	2.73
Malpractice RVU	0.05
Total RVU	3.85
Medicare national rate	$128.59
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	$128.59
HOPD (APC 5721) Hospital outpatient department	$131.46

Common denial reasons

The recurring reasons claims for CPT 95875 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Lack of medical necessity documentation — payers require documented clinical suspicion of metabolic myopathy; vague 'muscle pain' without workup context triggers denial
Missing or inadequate serial specimen log — insurers audit whether multiple draws were actually performed as the code describes
ICD-10 mismatch — billing a nonspecific musculoskeletal diagnosis instead of a metabolic or neuromuscular code inconsistent with the procedure purpose
Supervision level not met — if performed by ancillary staff without documented physician direct supervision where required by payer policy
Duplicate claim or unbundling of specimen handling charges billed separately without appropriate modifiers or justification

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Which diagnoses support medical necessity for CPT 95875?

ICD-10 codes pointing to metabolic myopathy or glycogen storage disease (e.g., E74.04 for McArdle disease, G71.2x for congenital myopathies, M62.89 for other specified muscle disorders) align best. Nonspecific codes like M79.3 (panniculitis) or M79.7 (fibromyalgia) will not survive a medical necessity review.

02Can 95875 be billed the same day as EMG or nerve conduction studies?

Yes, if clinically distinct and separately documented. The ischemic exercise test evaluates metabolic muscle function; EMG/NCS evaluate nerve and motor unit integrity. Append modifier 59 to the lower-RVU code to signal a distinct service, and ensure the note addresses both clinical questions separately.

03Is 95875 subject to a global period?

No. The global period is XXX, meaning no pre- or post-operative bundling rules apply. Bill on the date of service without global period restrictions.

04Does Medicare cover 95875 for McArdle disease workup in orthopedic patients?

Medicare coverage is determined by local coverage determinations (LCDs) from the applicable MAC. There is no national coverage determination (NCD) specific to 95875. Verify with your MAC before assuming coverage; some require prior authorization or a neurology or metabolic medicine ordering physician depending on jurisdiction.

05What level of physician supervision is required when ancillary staff performs the test?

CMS requires direct supervision in the office setting for diagnostic tests billed under the physician fee schedule when performed by ancillary staff. The physician must be in the office suite and immediately available — not just available by phone. Document the supervising physician's presence in the encounter record.

06Why does 95875 appear in orthopedic billing data if it's a neuromuscular code?

Orthopedic surgeons evaluating patients with unexplained exercise-induced myalgia, post-exertional cramping, or recurrent rhabdomyolysis order this test to rule out metabolic myopathy before attributing symptoms to structural pathology. CMS PUF data confirms Orthopedic Surgery as a top billing specialty.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the clinical indication (specific symptoms prompting metabolic myopathy workup), the ischemic induction method, the exercise protocol, and the exact time points of serial specimen collection from dictation. It flags if lactate and ammonia interpretation language is absent from the note — the most common reason payers reclassify this as a simple venipuncture rather than reimbursing the full ischemic exercise test.

See how Mira captures CPT 95875 documentation