CPT 95938 SSEP Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 95938: Short‑Latency Somatosensory Evoked Potential Study

CPT code 95938 denotes a short‑latency somatosensory evoked potential (SSEP) study with stimulation of peripheral nerves or skin sites in both upper and lower limbs and recording from central nervous system structures. This diagnostic neurophysiology code is used nationally to evaluate sensory pathway conduction for a range of neurological conditions and perioperative monitoring needs. Its use affects hospital outpatient and ambulatory neurodiagnostic billing and informs clinical decision making in neurology and neurosurgery.

Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for SSEP testing, typical sites of service, common billing considerations, and benchmarking information where available. The publication summarizes reimbursement patterns, coding guidance issues, and policy updates that influence coverage and payment. It also outlines where SSEP testing fits within diagnostic workflows and what clinicians and billing professionals should expect when documenting and submitting claims for CPT code 95938.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare95938CPTsomatosensory-evoked-potentialsneurophysiologydiagnostic-testinghospital-outpatientambulatory-surgery-center

Billing Code Overview

CPT code 95938 describes a short‑latency somatosensory evoked potential (SSEP) study that involves stimulation of peripheral nerves or skin sites in both the upper and lower limbs with recording of resulting evoked potentials from the central nervous system. This procedure assesses conduction in sensory pathways from peripheral sites through the spinal cord to cortical and subcortical structures.

Service type: Diagnostic neurophysiology procedure (evoked potential study)
Typical site of service: Hospital outpatient department, ambulatory surgery center, or specialized neurodiagnostic laboratory where neurophysiology testing is performed

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Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with progressive numbness and gait instability is referred to a neurodiagnostic lab for a short-latency somatosensory evoked potential (SSEP) study. The neurologist orders bilateral upper- and lower-limb stimulation to evaluate conduction in peripheral nerves, dorsal columns, brainstem, and cortical somatosensory pathways. The clinical workflow: the patient arrives at an outpatient neurodiagnostic facility or hospital neurophysiology lab; consent and clinical history are confirmed; skin is prepared and stimulating electrodes placed over peripheral nerves (e.g., median and posterior tibial nerves) and recording electrodes positioned over scalp, cervical, and subcortical sites. The technologist performs standardized stimulation and records responses; waveforms are averaged and measured for latency and amplitude. The physician (neurologist or neurophysiologist) interprets the findings, documents results, and provides a diagnostic report. Typical sites of service include outpatient neurodiagnostic laboratories, hospital neurophysiology/EEG suites, and ambulatory surgery centers when performed as part of intraoperative monitoring or preoperative evaluation.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the interpretation by the physician separate from technical recording.

CPT 95933: Orbicularis Oculi (Blink) Reflex Electrodiagnostic Test

CPT-95926-LOWER-LIMB-SHORT-LATENCY-SSEP

CPT 95926: Short-Latency Somatosensory Evoked Potential, Lower Limbs

CPT-95939-CENTRAL-MOTOR-EVOKED-POTENTIAL-UPPER-LOWER-LIMBS

CPT 95939: Central Motor Evoked Potential Study, Upper and Lower Limbs

CPT-95930-VISUAL-EVOKED-POTENTIAL-TESTING

CPT 95930: Visual Evoked Potential Testing

CPT-95928-CENTRAL-MOTOR-EVOKED-POTENTIAL-UPPER-LIMB

CPT 95928: Central Motor Evoked Potential Study for Upper Limb Muscles

CPT-95927-SHORT-LATENCY-SOMATOSENSORY-EVOKED-POTENTIAL-STUDY

CPT 95927: Short-Latency Somatosensory Evoked Potential Study

CPT-95929-CENTRAL-MOTOR-EVOKED-POTENTIAL-LOWER-LIMB

CPT 95929: Central Motor Evoked Potential Study for Lower Limbs

CPT-95925-UPPER-LIMB-SOMATOSENSORY-EVOKED-POTENTIAL-SSEP

CPT 95925: Short‑Latency Somatosensory Evoked Potential, Upper Limbs

CPT-95937-NEUROMUSCULAR-JUNCTION-REPETITIVE-STIMULATION

CPT 95937: Neuromuscular Junction Testing by Repetitive Stimulation

TC

Taxonomy Code	Specialty	Notes
2084N0400X	Neurology	Physicians who interpret SSEPs and manage neurodiagnostic testing.
207R00000X	Neurological Surgery	May request or participate in intraoperative monitoring or pre/postoperative neurophysiologic assessment.
261QM0801X	Clinical Neurophysiology	Specialists who perform and interpret evoked potentials and EEGs.
363L00000X	Physical Medicine & Rehabilitation	Clinicians who may order SSEPs in evaluation of peripheral and spinal cord disorders.
174400000X	Diagnostic Radiology	Radiologists occasionally involved in multidisciplinary neurodiagnostic interpretation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G56.0`	Carpal tunnel syndrome	Peripheral median nerve conduction issues may prompt SSEP to evaluate somatosensory pathway integrity.
`G54.0`	Brachial plexus disorders	SSEP can help localize sensory pathway compromise from plexus injuries.
`G83.4`	Cauda equina syndrome	Lower-limb SSEP testing assists in assessing dorsal column and nerve root function.
`G37.9`	Demyelinating disease of central nervous system, unspecified	SSEPs assess central conduction delays typical in multiple sclerosis and related disorders.
`M48.06`	Spinal stenosis, lumbar region	SSEPs may be used to evaluate spinal cord and nerve root conduction in compressive myelopathy.
`R20.2`	Paresthesia of skin	Non‑specific sensory symptoms often evaluated with SSEPs alongside nerve conduction studies.
`G25.0`	Essential tremor	SSEPs may be obtained in comprehensive neurophysiologic assessment when differential includes central causes.
`R26.2`	Difficulty in walking, not elsewhere classified	Gait disturbance may prompt SSEPs to evaluate spinal cord or central sensory pathway involvement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`95938`	Short‑latency somatosensory evoked potentials; stimulation of peripheral nerves or skin sites in both upper and lower limbs with recording from the central nervous system	Primary code described — bilateral upper and lower limb stimulation with central recordings.
`95937`	Short‑latency somatosensory evoked potentials; stimulation of peripheral nerves or skin sites in upper OR lower limbs with recording from the central nervous system	Used when only upper limbs OR lower limbs are stimulated instead of both.
`95940`	Short‑latency somatosensory evoked potentials; cortical responses only, stimulation of upper AND lower limbs	Used when only cortical recordings are obtained without subcortical/brainstem derivations.
`95920`	Somatosensory evoked potentials for long‑latency (cortical) responses — upper or lower limbs (varies by report)	Performed when extended/long‑latency cortical testing is required in addition to short‑latency SSEPs.
`95816`	Electroneurography, motor and sensory, conduction and latency/velocity studies; percutaneous needle or surface stimulation (nerve conduction studies)	Commonly performed alongside SSEPs to assess peripheral nerve function and help localize lesions.
`95812`	Electromyography; needle, one extremity with or without related paraspinal areas	Performed when neuromuscular disorders or radiculopathies are part of differential diagnosis and complementary to SSEP testing.

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