Short-latency somatosensory evoked potential study stimulating peripheral nerves in the lower limbs, with recording over the spinal cord and brain.
- Medicare
- $135.94
- Work RVU
- 0.53
- Global, days
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Clinical reason, such as myelopathic signs or unexplained leg sensory loss
- Nerves stimulated and sides
- Recording sites and latencies
- Reference values
- Interpretation
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 2 cited references ↓
95926 is the lower limb version of the diagnostic SSEP. The tibial or peroneal nerve is stimulated and the response is recorded along the spine and scalp. It tests the sensory pathway through the whole spinal cord.
Spine surgeons order it when a patient has leg symptoms that do not match a lumbar root pattern and a thoracic or cervical cord problem is possible. It can also document a baseline before thoracolumbar surgery or scoliosis correction.
Bill 95938 when both upper and lower limbs are tested; 95925 and 95926 do not go together. Intraoperative monitoring has its own codes. The usual denial is a diagnosis that only describes back pain or lumbar radiculopathy, which most payers do not see as a reason for an evoked potential study.
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 (0.53) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.07) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.53 |
| Practice expense RVU | 3.49 |
| Malpractice RVU | 0.05 |
| Total RVU | 4.07 |
| Medicare national rate | $135.94 |
| 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 | $135.94 |
HOPD (APC 5722) Hospital outpatient department | $220.60 |
Common denial reasons
The recurring reasons claims for CPT 95926 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Diagnosis limited to low back pain or lumbar radiculopathy
- Billed with 95925 instead of 95938
- Used as routine preoperative screening without indication
- Intraoperative use billed as diagnostic
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01Does lumbar radiculopathy support 95926?
02What code covers upper and lower limb SSEPs together?
03Can 95926 be split into professional and technical components?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
Mira Scribe
Mira Scribe records upper motor neuron signs, balance problems, and sensory levels at the visit, which supports ordering a lower limb SSEP.
See how Mira captures CPT 95926 documentation