CPT 95869
Global XXX ActiveNdl emg thrc paraspinal musc
CPT 95869 Billing & Documentation Guide
CPT code 95869 (Ndl emg thrc paraspinal musc) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.36, a non-facility practice expense RVU of 2.46, and a malpractice RVU of 0.03, a total non-facility RVU of 2.85 and facility RVU of 2.85. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $98.88, though rates vary from $83.12 to $132.37 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95869, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 95869 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 95869 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 95869
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.36 | 0.36 |
| Practice Expense RVU | 2.46 | 2.46 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 2.85 | 2.85 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95869
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $110.22 | $110.22 | $102.82 - $132.37 | 29 |
| Florida | $96.41 | $96.41 | $92.08 - $100.09 | 3 |
| Georgia | $91.63 | $91.63 | $86.51 - $96.74 | 2 |
| Illinois | $93.38 | $93.38 | $88.61 - $98.27 | 4 |
| Michigan | $90.59 | $90.59 | $88.17 - $93 | 2 |
| North Carolina | $89.33 | $89.33 | $89.33 - $89.33 | 1 |
| New York | $105.62 | $105.62 | $90.79 - $112.35 | 5 |
| Ohio | $88.05 | $88.05 | $88.05 - $88.05 | 1 |
| Pennsylvania | $93.69 | $93.69 | $88.4 - $98.97 | 2 |
| Texas | $93.91 | $93.91 | $87.73 - $99.87 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 95869
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95869 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90901 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 95870 | Column 1 (primary), can be billed with modifier | Yes | HCPCS/CPT procedure code definition |
| 95873 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95874 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95887 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95900 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95903 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95904 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 95869
What does CPT code 95869 mean? +
CPT code 95869 represents: Ndl emg thrc paraspinal musc. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95869? +
The 2026 Medicare national average non-facility payment for CPT 95869 is $98.88. Rates range from $83.12 to $132.37 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95869? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 95869? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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