# 95874



## celcano (Mar 25, 2019)

My physician did a procedure where he injected Botox into 3 extremities under EMG guidance.  I have an article that says we should bill EMG guidance for each extremity.  However, when I tried billing for 3 units, it has hit an edit in my billing software that says 95874 has an MUE of 1.  Is this right?  Can I only bill for 1 unit?  Any advice would be greatly appreciated.
Thank you!


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## LisaAlonso23 (Mar 26, 2019)

95874 is an add-on code, so it may not be billed alone. That may be your problem.


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## celcano (Mar 27, 2019)

I am billing 95874 with 64642 x 1 and 64643 x 2.


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## marvelh (Apr 17, 2019)

There is a difference of policy between CPT and Medicare.  CPT parenthetical note for 95873& 95874 - "Do not report more than one guidance code for each corresponding chemodenervation code."  Which means that you would be able to bill 95874 with 3 units of service in your scenario.

However, Medicare takes a different stance.  It has a MUE limit of 1 unit of service as well as the following excerpt from the NCCI manual (bold emphasis added) - "CPT code 95873 describes electrical stimulation for guidance in conjunction with chemodenervation, and CPT code 95874 describes needle electromyography for guidance in conjunction with chemodenervation. *During a patient encounter only one of these codes may be reported with a maximum of one (1) unit of service* for guidance in conjunction with chemodenervation regardless of the number of muscles chemodenervated."

Some commercial payers follow Medicare's limitations and may not pay for more than 1 unit of service for the guidance.

Take care,
Marvel


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## gayathriI (Jul 8, 2021)

Same scenario, My physician did a procedure where he injected Botox into1 extremities under EMG guidance. Mr question is do i need to add any modifier for this procedures.
 64642
95874. Please help me experts!!
TIA.


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