2025 CPT code 95860
(Active) Effective Date: N/A Revision Date: N/A Neurology - Electromyography Procedures Medicine Services and Procedures > Neurology and Neuromuscular Procedures Feed
Needle electromyography of one extremity, with or without related paraspinal areas.
Modifiers 26 (professional component), 59 (distinct procedural service), and others may be applicable depending on the specific circumstances of the service.
Medical necessity is established when the EMG is ordered to evaluate for neuromuscular disorders (e.g., myopathy, neuropathy, radiculopathy) based on the patient's clinical presentation and symptoms.Supporting documentation, such as medical history, physical examination, and other diagnostic tests, should justify the necessity of the procedure.
The clinical responsibility lies with a neurologist, physiatrist, or other qualified healthcare professional trained in performing and interpreting electromyography. The physician inserts needles into muscles to record electrical activity, interprets the results, and creates a report.
- Medicine Services and Procedures > Neurology and Neuromuscular Procedures
- Electromyography Procedures
In simple words: This test checks the electrical activity of muscles in one arm or leg (and sometimes nearby back muscles).A tiny needle with electrodes is inserted into the muscles to measure their electrical signals.The doctor uses this information to diagnose muscle and nerve problems.
This code reports needle electromyography (EMG) of one extremity, which may include related paraspinal areas (excluding thoracic, T3-T11).A minimum of five muscles must be studied per limb, innervated by at least three nerves or four spinal levels.The procedure involves inserting needle electrodes into muscles to record electrical activity during rest and contraction. The recording is interpreted by a qualified healthcare professional.Thoracic paraspinal muscles (T3-T11) should be reported separately using 95869 if examined.
Example 1: A patient presents with weakness in their right arm. The neurologist performs an EMG of the right arm and related paraspinal muscles to evaluate for nerve compression or myopathy., A patient reports persistent low back pain.An EMG of the lower extremity and related paraspinal muscles is conducted to assess the presence of radiculopathy., A patient with suspected muscular dystrophy undergoes an extensive EMG of both lower extremities, including related paraspinal muscles, for comprehensive evaluation of muscle function.
Detailed medical history, including symptoms, onset, and progression; physical examination findings; results of the EMG study including waveform characteristics and interpretations; physician's diagnostic and treatment plan; supporting documentation for medical necessity.
** This code should only be used when the minimum number of muscles are studied.Documentation must clearly support the medical necessity and the number of muscles studied. If nerve conduction studies are done on the same day, different codes are used.Refer to the AMA CPT manual for the most up-to-date information.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: RVUs vary by payer and location. Check your local fee schedule for specific values.
- Global Days: The global period is not explicitly defined for this code.Refer to payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: Modifier TC (technical component) is not applicable to this code as it represents the professional component of the service.
- Fee Schedule: Historical fee schedule data is not provided but can be obtained from your local Medicare Administrative Contractor (MAC) or other payer sources.
- Specialties:Neurology, Physical Medicine and Rehabilitation
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center