Summary & Overview
CPT 95875: Ischemic Exercise Test for Metabolic Muscle Disorders
CPT code 95875 denotes an induced ischemic exercise test, most commonly the ischemic forearm test, used to evaluate metabolic muscle disorders such as McArdle disease. This specialized diagnostic procedure recreates ischemic conditions while the patient performs exercise to evaluate muscle metabolic responses. Nationally, it is an important tool for confirming rare metabolic myopathies and guiding clinical care and genetic evaluation.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical indications and the typical care setting, as well as operational context for billing and common modifier use (listed separately). The publication provides benchmarks and coverage patterns where available, policy interpretations that affect claims processing, and practical notes on site-of-service considerations for outpatient neuromuscular testing.
This summary is designed for clinicians, billing professionals, and policy analysts seeking a national overview of CPT code 95875, including clinical context, payer coverage scope, and what to expect when documenting and submitting claims for ischemic exercise metabolic testing.
Billing Code Overview
CPT code 95875 describes a diagnostic procedure in which a provider has the patient perform exercise under induced ischemic conditions. The test is most commonly the ischemic forearm exercise test used to evaluate metabolic muscle disorders such as McArdle disease. This procedure assesses muscle metabolic response to exercise when blood flow is occluded, measuring biochemical and clinical responses.
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Service type: Diagnostic metabolic/exercise testing
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Typical site of service: Hospital outpatient clinic, specialty neuromuscular or metabolic testing laboratory, or ambulatory surgical center with appropriate monitoring capabilities
Clinical & Coding Specifications
Clinical Context
A 14-year-old adolescent with lifelong exercise intolerance, muscle cramping, and episodic myoglobinuria is referred to a neuromuscular clinic to evaluate for a suspected glycogen storage myopathy such as McArdle disease. The clinical workflow begins with a focused history and neurologic/musculoskeletal exam, baseline laboratory studies including creatine kinase and metabolic panel, and counseling on risks of ischemic exercise testing. On the test day the patient is positioned with an arm cuff for arterial occlusion; baseline blood samples are obtained. The provider instructs the patient to perform repetitive forearm exercises (grip contractions) while ischemia is induced using the cuff to create an ischemic forearm test under direct supervision. Serial blood draws are collected to measure lactate, ammonia, and other metabolites before, during, and after exercise. The provider monitors vital signs and limb perfusion, documents all time points, and interprets the metabolic response to differentiate disorders of glycogenolysis and glycolysis. Results inform further genetic testing, counseling, and management planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Principal physician service | When this service represents the primary physician encounter on the day of the procedure. |