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    OpenPayerBilling CodesUrodynamic Procedures on the BladderCPT cpt-51784-anal-or-urethral-sphincter-electrical-activity-testing
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    CPT 51784: EMG of Anal or Urethral Sphincter Muscles

    Medicare pays $46 and commercial payers pay $156 on average nationally for this procedure.

    CPT code 51784 represents an electromyography (EMG) test that measures electrical activity in the anal or urethral sphincter muscles, used to assess neuromuscular function of the pelvic floor; service type: diagnostic electrodiagnostic study; typical site of service: outpatient clinic, urology or colorectal procedure suite, or specialized neurophysiology lab.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM), Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®), Lumbar Microdiscectomy.

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    National Reimbursement Benchmarks

    Medicare’s national mean rate of $45.8 sits well below BUCA’s average commercial mean of $155.6, highlighting a substantial gap between federal reimbursement and this commercial benchmark. The difference of $109.8 in mean rates underscores that Medicare is closer to the lower end of the payer spectrum, while BUCA represents a higher-cost commercial average for CPT 51784.

    Examining dispersion using the interquartile spread (P75 minus P25) highlights variation across payers: Blue Cross Blue Shield’s spread is $61.0 (P75 $217.9 minus P25 $157.1), UnitedHealth Group’s spread is $80.0 (P75 $135.8 minus P25 $53.8), Aetna’s spread is $64.0, Cigna’s spread is $92.1, and BUCA’s spread is $69.1. Cigna shows the widest IQR at $92.1, indicating the largest mid‑range variability, while Blue Cross Blue Shield is relatively tightest at $61.0.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult referred to a urology or colorectal clinic for evaluation of fecal or urinary incontinence, chronic constipation with suspected pelvic floor dyssynergia, or neurogenic bowel/bladder dysfunction. Common presenting features include involuntary stool leakage, urgency, incomplete evacuation, or poor sphincter control after neurologic injury. Relevant history includes multiple sclerosis, spinal cord injury with paraplegia or quadriplegia, post-stroke hemiplegia, or progressive spastic paraplegia.

    The clinical workflow: a specialist (urologist, colon & rectal surgeon, or proctologist) performs an initial assessment including focused neurologic and pelvic floor exam and reviews prior imaging and voiding/bowel diaries. When neuromuscular dysfunction of the anal or urethral sphincter is suspected, the clinician schedules sphincter electromyography using 51784 to measure electrical activity of the sphincter muscles. The procedure is typically done in an outpatient clinic, ambulatory surgery center, or hospital outpatient department. The patient is positioned appropriately (lithotomy or left lateral) and consented. After skin preparation and possible local anesthesia, a specialized concentric or single-fiber needle is inserted into the external anal or urethral sphincter to obtain motor unit potentials, recruitment patterns, and spontaneous activity. Findings are interpreted with correlation to clinical examination and prior studies (uroflowmetry, cystometrogram, or needle EMG 51785 when performed). Results guide management decisions such as pelvic floor biofeedback, neuromodulation, surgical repair, or referral to neurology for progressive neuromuscular disease.

    Related CPT Codes

    CPT CodeDescription

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    208C00000X
    208D00000X
    2278C0205X
    332800000X
    1223X2210X
    364SE0003X
    202C00000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    G04.1Tropical spastic paraplegia
    G35
    G81.01Flaccid hemiplegia affecting right dominant side
    G81.02Flaccid hemiplegia affecting left dominant side
    G81.03Flaccid hemiplegia affecting right nondominant side
    G81.04Flaccid hemiplegia affecting left nondominant side
    G81.11Spastic hemiplegia affecting right dominant side
    G81.12Spastic hemiplegia affecting left dominant side
    G81.13Spastic hemiplegia affecting right nondominant side
    G81.14Spastic hemiplegia affecting left nondominant side

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)Kaiser Permanente2027-01-01
    Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)bcbsvermont2026-11-01
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Responsive Neurostimulation for Focal EpilepsyPremera Bluecross2026-10-14
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    High-Intensity Focused UltrasoundMass General Brigham Health Plan2026-10-01
    Vagal Nerve StimulationAmbetter Nevada2026-10-01

    Related Codes

    CPT-51725-CYSTOMETROGRAM-BLADDER-PRESSURE-CAPACITY-TEST

    CPT 51725: Cystometry to Measure Bladder Capacity and Pressure

    CPT-51726-CYSTOMETRY-BLADDER-PRESSURE-TESTING

    CPT 51726: Cystometry to Measure Bladder Capacity and Pressure

    CPT-51727-COMPLEX-CYSTOMETROGRAM-URETHRAL-PRESSURE-PROFILE

    CPT 51727: Complex Cystometrogram with Urethral Pressure Profile

    CPT-51728-COMPLEX-CYSTOMETROGRAM-VOIDING-PRESSURE-STUDIES

    CPT 51728: Complex Cystometrogram with Voiding Pressure Studies

    CPT-51729-COMPLEX-CYSTOMETROGRAM-VOIDING-URETHRAL-PRESSURE-PROFILE

    CPT 51729: Complex Cystometrogram with Voiding and Urethral Pressure Studies

    CPT-51736-UROFLOWMETRY-URODYNAMIC-FLOW-STUDY

    CPT 51736: Uroflowmetry (Urine Flow Measurement)

    CPT-51741-UROFLOWMETRY-URINARY-FLOW-MEASUREMENT

    CPT 51741: Uroflowmetry (Urine Flow Rate)

    CPT-51785-ANAL-URETHRAL-SPHINCTER-ELECTROMYOGRAPHY

    CPT 51785: Anal or Urethral Sphincter Electromyography

    CPT-51792-SPHINCTER-ELECTROMYOGRAPHY-ANAL-URETHRAL

    CPT 51792: Anal or Urethral Sphincter Electromyography

    CPT-51797-VOIDING-PRESSURE-URODYNAMIC-TEST

    CPT 51797: Voiding Pressure (Leak Point Pressure) Study

    Showing 1–10 of 11

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.

    Relationship to This Procedure
    51785Needle electromyography studies (EMG) of anal or urethral sphincter, any techniqueClosely related; alternative or complementary needle EMG technique often billed when additional EMG sampling is performed.
    51741Complex uroflowmetry (not needle)Performed before or after sphincter EMG to assess voiding dynamics and correlate with sphincter dysfunction.
    51728Complex cystometrogram with voiding pressure studiesUrodynamic study that complements sphincter EMG by evaluating bladder storage and voiding pressures in neurogenic bladder evaluation.
    90911Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometryTherapeutic follow-up; uses EMG findings to guide pelvic floor or sphincter biofeedback training.