2025 CPT code 95869
(Active) Effective Date: N/A Revision Date: N/A Neurology - Electromyography Procedures Medicine Services and Procedures > Neurology and Neuromuscular Procedures Feed
Needle electromyography of thoracic paraspinal muscles (excluding T1 and T12).
Modifier 26 (professional component) can be appended if only the physician's interpretation is billed; modifier 59 (distinct procedural service) may apply in certain situations, but use caution and refer to specific payer guidelines before using it.
Medical necessity for code 95869 is established when there is clinical suspicion of neuromuscular disorders, myopathies, radiculopathies, or other conditions affecting the thoracic paraspinal muscles.Supporting documentation such as imaging results, neurological examination findings, and the patient's symptoms are essential for justifying the study's necessity.
A neurologist or other qualified healthcare professional inserts needle electrodes into the thoracic paraspinal muscles (excluding T1 and T12) to record and interpret the electrical activity. The physician reviews the recordings and produces a report summarizing the findings for diagnosis and management.
- Medicine Services and Procedures > Neurology and Neuromuscular Procedures
- Electromyography Procedures
In simple words: This test uses tiny needles to check the electrical signals in the muscles along your spine in your upper back. It helps doctors find problems with your nerves and muscles.
This CPT code describes a needle electromyography (EMG) procedure focusing on the thoracic paraspinal muscles, excluding the first (T1) and twelfth (T12) thoracic vertebrae.The procedure involves inserting needle electrodes into the targeted muscles to record and analyze their electrical activity. This helps diagnose neuromuscular disorders and other conditions affecting these muscles.The code is reported only once per session, regardless of the number of levels tested or whether it's unilateral or bilateral.
Example 1: A patient presents with chronic upper back pain of unknown etiology.The physician orders a needle EMG of the thoracic paraspinal muscles to evaluate for myopathy, radiculopathy, or other neuromuscular causes of the pain.Code 95869 would be appropriate if the study is limited to the thoracic region (excluding T1 and T12)., A patient with suspected thoracic outlet syndrome undergoes EMG testing. The physician focuses the examination on the relevant paraspinal muscles to assess for nerve compression or other neuromuscular involvement in the condition.95869 is billed if only thoracic paraspinal muscles (excluding T1 and T12) are examined., A patient with a history of trauma to the thoracic spine undergoes a focused EMG study to assess the condition of the paraspinal muscles. This targeted evaluation only includes muscles between T3 and T11. Code 95869 would be used for this limited study.
Detailed medical history, including the reason for the study.A description of the specific muscles examined, the locations of needle insertions, and the findings of the EMG study.Electrodiagnostic waveforms and numerical data from the study.The physician's interpretation and diagnosis based on the results. This information should be documented in the patient's chart.
** The descriptor specifically states "muscles" (plural), indicating that only one unit of 95869 can be billed per session, irrespective of the number of levels studied or whether the procedure is unilateral or bilateral.Modifier 50 (bilateral procedure) is not applicable. Always confirm with payer specific guidelines for billing practices.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: This information is not included in the provided text.Refer to the CMS Physician Fee Schedule for current RVU values.
- Global Days: This information is not provided in the source.The global period will vary depending on payer and specific circumstances. Further clarification needed.
- Payment Status: Active
- Modifier TC rule: Modifier TC (technical component) does not apply to this code, as it's a professional service.If the technical component is provided by a separate entity, it would be reported using separate codes.
- Fee Schedule: This information is not provided and requires reference to historical fee schedules and local/payer reimbursement guidelines.
- Specialties:Neurology, Electromyography
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgery Center, Other clinics