Summary & Overview
CPT 95867: Needle EMG of Cranial Nerve–Innervated Muscles, Computerized Recording
CPT code 95867 covers needle electromyography (EMG) of muscle(s) innervated by cranial nerves, recording electrical activity at rest and during contraction with computerized waveform display and audible output. This electrodiagnostic procedure supports diagnosis of neuromuscular disorders affecting cranial-nerve–innervated muscles (for example, facial or bulbar muscles) and can influence clinical decisions about further testing, medical management, or referral to specialists. Nationally, accurate coding of this service matters for clinical documentation, appropriate payment, and quality measurement of neuromuscular diagnostic services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses common payer coverage patterns and reimbursement considerations for electrodiagnostic services, recognizing payer-specific policies may differ.
Readers will learn the clinical context and procedural scope of CPT code 95867, typical service settings, and what to expect in payer coverage discussions. The publication provides benchmarks related to utilization and payment where available, highlights policy implications for neurodiagnostic services, and summarizes coding relationships to related electrodiagnostic procedures. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 95867 describes insertion of a needle electrode into muscle(s) innervated by cranial nerves on one side of the body with recording of electrical activity during rest and contraction. The provider uses a computer to convert electrical activity into waveforms and a loudspeaker to render these recordings as audible sounds.
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Service type: Diagnostic electrodiagnostic testing of cranial-nerve–innervated muscle(s) using needle electromyography
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Typical site of service: Outpatient neurodiagnostic laboratory, hospital outpatient department, or clinic setting where electrodiagnostic studies and needle electromyography are performed
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient is referred to a neuromuscular specialist for evaluation of unilateral facial weakness and intermittent twitching after an episode of facial trauma. The clinician performs needle electromyography of muscles innervated by cranial nerves on the affected side using a needle electrode to record spontaneous and voluntary motor unit activity. A computer converts electrical signals to waveforms and a loudspeaker provides audible feedback during testing. Typical workflow includes informed consent, review of prior imaging and labs, targeted clinical exam of cranial nerve function, sterile skin preparation, selective needle electrode insertion into facial or bulbar muscles (for example, orbicularis oculi, orbicularis oris, masseter, or tongue muscles), rest and activation recordings, interpretation of findings, and documentation of needle EMG results and impressions in the medical record. Typical site of service is an outpatient neurology or physiatry clinic; this may also occur in an ambulatory surgery center or hospital inpatient setting for critically ill patients. The service type is diagnostic needle electromyography of cranial nerve–innervated muscles performed by a physician or qualified health professional to evaluate neuromuscular transmission, denervation, reinnervation, or motor unit recruitment patterns.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician’s interpretation and report separate from technical equipment or facility resources |