CPT 95911 Nerve Conduction Benchmarks & Reimbursement | OpenPayer

Summary & Overview

CPT 95911: Nerve Conduction Studies, 9–10 Studies

CPT code 95911 represents nerve conduction studies involving 9–10 individual tests, a critical diagnostic tool in neurology and neuromuscular medicine. This procedure is widely used to evaluate peripheral nerve function and is essential for diagnosing conditions such as carpal tunnel syndrome and other neuropathies. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for patients across the United States.

This publication provides a comprehensive overview of 95911, including its clinical context, typical sites of service, and its role in the broader landscape of neurology and physical medicine. Readers will gain insight into payer coverage, relevant policy updates, and benchmarks related to the use of this code. The analysis also highlights associated modifiers and taxonomies, offering clarity on billing practices and compliance requirements. By understanding the nuances of 95911, stakeholders can better navigate the complexities of medical billing and reimbursement for nerve conduction studies.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 95911nerve conduction studiesneurologyneuromuscular proceduresoutpatient servicesmedical billingclinical benchmarkspolicy updatesphysical medicinediagnostic testing

CPT Code Overview

CPT code 95911 is used to report nerve conduction studies involving 9–10 individual studies. This procedure is a key component in the evaluation of neuromuscular disorders and is commonly performed within the field of neurology and neuromuscular medicine. Typical sites of service include outpatient clinics or office settings, such as Place of Service 11. The nerve conduction study helps clinicians assess the function of peripheral nerves, aiding in the diagnosis and management of conditions like carpal tunnel syndrome and other neuropathies.

Clinical & Coding Specifications

Clinical Context

A patient presents to a neurology or physical medicine and rehabilitation clinic with symptoms suggestive of nerve dysfunction, such as numbness, tingling, or weakness in the upper limbs. The clinician suspects carpal tunnel syndrome based on history and physical examination. To confirm the diagnosis and assess the severity, the provider orders nerve conduction studies. During the outpatient visit, 9–10 individual nerve conduction studies are performed, targeting relevant nerves in the affected limb(s). The procedure is typically conducted in an office or outpatient setting (e.g., Place of Service 11). Results are interpreted by a neurologist or physiatrist to guide further management.

Coding Specifications

Modifiers:
- TC: Technical component. Used when only the technical aspect of the procedure (e.g., equipment use, technician performance) is billed.
- 26: Professional component. Used when only the professional aspect (e.g., interpretation and report by the physician) is billed.
Provider Taxonomies:

Taxonomy Code	Specialty Name

National Reimbursement Benchmarks

National mean rates for CPT code 95911 show a significant gap between Medicare and commercial payers. Medicare's mean rate is $152.24, while the BUCA (average commercial) mean rate stands at $208.22, highlighting a difference of $55.98 per claim.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Blue Cross Blue Shield exhibits the widest spread at $90.13, while Aetna has the tightest range at $73.46. This suggests that BCBS rates are more variable nationally, whereas Aetna's rates are more consistent.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a substantial rate spread for CPT code 95911, particularly among commercial payers. For example, Blue Cross Blue Shield's 75th percentile rate is $510.06, while its 25th percentile is $333.00, resulting in a spread of $177.06. UnitedHealth Group also shows a notable spread, with a 75th percentile of $404.67 and a 25th percentile of $360.67. Medicare's spread is $116.50, from $93.00 to $209.50. This wide variation highlights significant differences in reimbursement depending on payer and provider contract.

Compared to national averages, Alaska's commercial payers consistently reimburse at much higher rates for CPT code 95911. The mean rates for Aetna, Blue Cross Blue Shield, Cigna, UnitedHealth Group, and BUCA in Alaska all exceed their respective national benchmarks by a considerable margin. The table and chart below present the full breakdown of payer-specific rates in Alaska.

Key Insights for Alaska

Blue Cross Blue Shield and UnitedHealth Group have the highest mean rates for CPT 95911 in Alaska, both above $400.
Medicare is the lowest paying payer in Alaska, with a mean rate of $147.64.
All commercial payers in Alaska reimburse significantly above their respective national averages for CPT 95911.

CPT 95908: Nerve Conduction Study, Three to Four Studies

CPT-95905-NERVE-CONDUCTION-STUDIES-MOTOR-SENSORY

CPT 95905: Motor and Sensory Nerve Conduction Studies

95913-NERVE-CONDUCTION-STUDIES-13-OR-MORE

CPT 95913: Nerve Conduction Studies, 13 or More

CPT-95912-NERVE-CONDUCTION-STUDIES-11-12

CPT 95912: Nerve Conduction Studies, 11–12 Tests

CPT-95907-NERVE-CONDUCTION-STUDY-1-2-NERVES

CPT 95907: Nerve Conduction Study, One or Two Nerves

CPT-95909-NERVE-CONDUCTION-STUDY-FIVE-SIX-STUDIES

CPT 95909: Nerve Conduction Study, Five to Six Tests

95910-NERVE-CONDUCTION-STUDIES-SEVEN-OR-EIGHT

CPT 95910: Nerve Conduction Studies, Seven or Eight Studies

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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