CPT 95913 Nerve Conduction Reimbursement Benchmarks | OpenPayer

Summary & Overview

CPT 95913: Nerve Conduction Studies, 13 or More

CPT code 95913 represents nerve conduction studies involving 13 or more individual tests, a procedure commonly performed in neurology to diagnose and evaluate a wide range of peripheral nerve disorders. This code is significant nationally due to its role in identifying conditions such as carpal tunnel syndrome, polyneuropathy, and neuralgia, which affect millions of Americans. The procedure is typically conducted in an office setting and is integral to the clinical workup for patients presenting with symptoms of nerve dysfunction.

Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, billing practices, and clinical context for 95913. Readers will gain insights into current benchmarks, policy updates, and the clinical importance of nerve conduction studies. The article also highlights common modifiers used in billing, associated physician taxonomies, relevant ICD-10 diagnoses, and related CPT codes, offering a complete picture of how this procedure fits into the broader landscape of neurology services and medical billing.

This summary equips healthcare professionals, billing specialists, and policy analysts with the essential information needed to understand the utilization and reimbursement landscape for nerve conduction studies, ensuring clarity on payer requirements and clinical indications.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 95913nerve conduction studiesneurologymedical billingoffice settingclinical neurophysiologyICD-10 diagnosesprocedure benchmarkspolicy updatesmodifier codes

CPT Code Overview

CPT code 95913 is used to report nerve conduction studies involving 13 or more studies. This procedure is a key diagnostic tool in neurology, allowing clinicians to assess the function and integrity of peripheral nerves. The typical site of service for this code is the office setting (POS 11), where specialized equipment and expertise are available to perform comprehensive nerve conduction testing. These studies are essential for evaluating patients with suspected neuropathies, nerve injuries, or other neurological disorders.

Clinical & Coding Specifications

Clinical Context

A patient presents to a neurology office with symptoms such as numbness, tingling, or weakness in the extremities. The neurologist suspects a peripheral nerve disorder, such as carpal tunnel syndrome, polyneuropathy, or neuralgia. To evaluate the function of multiple nerves, the provider performs nerve conduction studies, completing 13 or more individual studies as part of a comprehensive assessment. This procedure is typically performed in an office setting (Place of Service 11) by a physician specializing in neurology, clinical neurophysiology, or neurodevelopmental disabilities.

Coding Specifications

Modifiers:
- 26: Professional Component – Used when only the physician's interpretation and report are billed.
- TC: Technical Component – Used when only the technical portion (equipment, technician) is billed.
- 59: Distinct Procedural Service – Used to indicate a procedure or service was distinct or independent from other services performed on the same day.
- 76: Repeat Procedure by Same Physician – Used when the same physician repeats the procedure.
Provider Taxonomies:

National Reimbursement Benchmarks

Nationally, the mean rate for CPT code 95913 is highest among UnitedHealth Group at $326.20, followed by Cigna at $317.63. The average commercial benchmark (BUCA) stands at $277.23, which is notably higher than the Medicare mean rate of $207.23. This highlights a substantial gap between commercial and government reimbursement levels for this service.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare shows the widest spread at $167.50, indicating significant variability in rates. Among commercial payers, Cigna and UnitedHealth Group also exhibit wide dispersions ($169.33 and $163.67, respectively), while Aetna has the tightest range at $91.93. This suggests that Aetna's rates are more consistent nationally compared to other payers.

The table and chart below present a detailed breakdown of national benchmarks for CPT code 95913 across major payers.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a notably wide rate spread for CPT code 95913, especially among commercial payers. For example, Blue Cross Blue Shield's 75th percentile rate is $576.50, while its 25th percentile is $379.59, resulting in a spread of $196.91. UnitedHealth Group also shows a substantial spread, with a 75th percentile of $524.67 and a 25th percentile of $487.33. This indicates significant variability in negotiated rates across providers in the state.

Compared to national averages, Alaska's commercial payers consistently reimburse at much higher rates. UnitedHealth Group, Blue Cross Blue Shield, and Aetna all have mean rates well above their national benchmarks. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting these differences and the range of reimbursement values across the state.

Key Insights for Alaska

UnitedHealth Group offers the highest mean reimbursement rate for CPT 95913 in Alaska at $535.88, while Medicare is the lowest at $201.19.
All commercial payers in Alaska reimburse significantly above their respective national averages, with UnitedHealth Group and Blue Cross Blue Shield showing the largest positive deviations.
The rate spread is widest for Blue Cross Blue Shield, indicating substantial variability in negotiated rates across providers.

CPT 95908: Nerve Conduction Study, Three to Four Studies

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

CPT 95905: Motor and Sensory Nerve Conduction Studies

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

CPT 95912: Nerve Conduction Studies, 11–12 Tests

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

CPT 95910: Nerve Conduction Studies, Seven or Eight Studies

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

CPT 95907: Nerve Conduction Study, One or Two Nerves

95911-NERVE-CONDUCTION-STUDIES-910

CPT 95911: Nerve Conduction Studies, 9–10 Studies

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

CPT 95909: Nerve Conduction Study, Five to Six Tests

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