2025 CPT code 95999
(Active) Effective Date: N/A Neurology and Neuromuscular Procedures Feed
Unlisted neurological or neuromuscular diagnostic procedure
Modifiers may be applicable depending on the specific circumstances of the procedure. For example, modifier 26 may be used if only the professional component is being billed. Modifier 52 may be used if the procedure is reduced in scope.
Medical necessity must be established for the unlisted neurological or neuromuscular diagnostic procedure. The documentation should clearly explain the clinical rationale for the procedure, linking it to the patient's signs, symptoms, and diagnosis.The documentation should also demonstrate that the procedure was necessary for diagnosis or treatment and that no other less invasive or less costly alternative was available.
The physician or other qualified healthcare professional performs and interprets the unlisted neurological or neuromuscular diagnostic procedure.
In simple words: This code is used when a doctor performs a neurological or neuromuscular diagnostic test that doesn't have its own specific code.
This code is used for neurological or neuromuscular diagnostic procedures that are not otherwise described in the CPT code set.
Example 1: A patient presents with unusual symptoms suggesting a rare neuromuscular disorder not covered by existing CPT codes. Specialized electrodiagnostic testing is performed to evaluate nerve and muscle function., A patient with suspected small fiber neuropathy undergoes quantitative sudomotor axon reflex testing (QSART), a procedure not specifically listed in the CPT manual, to assess sweat gland function., Following an unusual neurological event, a patient requires a novel diagnostic test involving advanced imaging and electrophysiological recordings, not described by other CPT codes, to pinpoint the cause.
The medical record must thoroughly document the performance of the unlisted procedure, including a detailed description of the procedure performed, the medical necessity for the procedure, the interpretation of results, and a clear explanation as to why no other existing CPT code accurately represents the service provided. Supporting documentation, such as test results and physician notes, should also be included.
** When billing with 95999, it is crucial to submit supporting documentation explaining the procedure and justifying why a specific CPT code isn't applicable.It is recommended to contact the payer beforehand for specific billing requirements.
- Specialties:Neurology, Neuromuscular Medicine, Clinical Neurophysiology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital