CPT 95870
Global XXX ActiveNdl emg lmtd std musc 1 xtr
CPT 95870 Billing & Documentation Guide
CPT code 95870 (Ndl emg lmtd std musc 1 xtr) 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 2.2, and a malpractice RVU of 0.03, a total non-facility RVU of 2.59 and facility RVU of 2.59. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $89.82, though rates vary from $75.66 to $119.85 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95870, 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 95870 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 4 units of 95870 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 95870
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.36 | 0.36 |
| Practice Expense RVU | 2.2 | 2.2 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 2.59 | 2.59 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95870
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 | $99.95 | $99.95 | $93.3 - $119.85 | 29 |
| Florida | $87.7 | $87.7 | $83.78 - $91.05 | 3 |
| Georgia | $83.34 | $83.34 | $78.76 - $87.92 | 2 |
| Illinois | $84.99 | $84.99 | $80.68 - $89.35 | 4 |
| Michigan | $82.43 | $82.43 | $80.24 - $84.62 | 2 |
| North Carolina | $81.22 | $81.22 | $81.22 - $81.22 | 1 |
| New York | $95.93 | $95.93 | $82.54 - $102.02 | 5 |
| Ohio | $80.12 | $80.12 | $80.12 - $80.12 | 1 |
| Pennsylvania | $85.18 | $85.18 | $80.43 - $89.93 | 2 |
| Texas | $85.36 | $85.36 | $79.82 - $90.68 | 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 95870
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95870 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 |
| 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 |
| 95885 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95886 | 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 95870
What does CPT code 95870 mean? +
CPT code 95870 represents: Ndl emg lmtd std musc 1 xtr. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95870? +
The 2026 Medicare national average non-facility payment for CPT 95870 is $89.82. Rates range from $75.66 to $119.85 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95870? +
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 95870? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team