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Neurology & Pain Management Coding Alert

Reader Questions:

Once per Session Is Enough for 95869

Published on Wed Apr 27, 2005

Question: May I report multiple units of 95869 for testing multiple spinal levels? Can I append modifier -50 for bilateral testing?


Illinois Subscriber


Answer: No and no.

CPT 95869 (Needle electromyography; thoracic paraspinal muscles [excluding T1 or T12]) describes electromyography of the thoracic paraspinal muscles. Because the descriptor specifies "muscles" (plural), you may report this code only once per session, regardless of the number of levels the neurologist tests.

And the CMS Physician Fee Schedule assigns a bilateral-procedure indicator of "0" to 95869, meaning that modifier -50 (Bilateral procedure) does not apply. You cannot receive additional reimbursement for bilateral testing.
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