A study published by The Lancet Neurology journal and cited by the World Health Organization (WHO) found that 1 in 3 people in the world (over 3 billion people!) are living with a neurological condition that increases their risk of disability, illness, and premature death.
In the United States, stroke, dementia, migraine, and Alzheimer’s disease make up most of the neurological disorders. Currently, around 6.9 million Americans have Alzheimer’s and other dementias. However, neurological examinations and procedures can detect these diseases early on and help healthcare providers manage their patients’ conditions.
In this blog, we have listed the most used CPT codes for neurology, covering these tests and procedures, and provided the coding guidelines to increase your clean claim submission rate.
10 Most Common Neurology CPT Codes
Here are the 10 most frequently reported neurology CPT codes based on the data collected from independent neurology centers and hospital-affiliated neurology departments across the country. Take a look!
Neurology CPT Codes for Routine Electroencephalography (EEG)
A routine electroencephalogram (EEG) test monitors a patient’s brain activity. The healthcare provider generally orders this diagnostic test when he suspects the patient to have epilepsy (a neurological disorder that causes unprovoked and repeated seizures).
During the routine EEG scanning, the technician places electrodes on the patient’s scalp, and these electrodes are connected to a machine that monitors the electrical activity inside the brain.
The two most reported neurology CPT codes for electroencephalography are stated below, and together, they make up nearly 10% of all neurological procedures performed around the country.
CPT Code 95816 – EEG Awake and Drowsy
The neurology CPT code 95816 is reported when a neurologist or a technician performs electroencephalography on a patient who is awake but drowsy. It helps the provider monitor the patient’s brain activity in the conscious state and identify possible abnormalities to detect epilepsy.
Please note that EEG scanning performed on a patient who is awake lasts around 20 minutes. However, the provider may request a sleep-deprived EEG when brain activity needs to be monitored during the patient’s lowered consciousness (drowsy) or subconscious state (asleep). In this case, the patient must stay awake at night and go to the outpatient neurology lab for EEG recording in the morning. EEG scanning while the patient is drowsy or asleep lasts almost an hour.
CPT Code 95819 – EEG Awake and Asleep
To check the changes in the electrical activity of the patient’s brain in the conscious and subconscious state, the provider performs an EEG when the patient is awake and when he falls asleep. Again, electrodes are placed on the patient’s scalp and connected to an electroencephalogram for seamless brain activity monitoring. Denoted by neurology CPT code 95819, the EEG test is usually performed on a sleep-deprived patient to detect epilepsy.
Neurology CPT Codes for Lumbar Puncture (Spinal Tap)
Lumbar puncture or spinal tap is a minimally invasive procedure to obtain cerebrospinal fluid (a clear fluid that protects and nourishes our brain and spinal cord). The procedure generally takes a minute or two and may be performed for diagnostic or therapeutic reasons.
The provider administers local anesthesia on the patient’s lower back and inserts a needle to remove the fluid. This fluid may then be tested for infections/tumors or drawn out to relieve pressure on the brain. The two most reported neurology CPT codes for lumbar puncture are explained below.
CPT Code 62270 – Diagnostic Lumbar Puncture
62270 is the neurology CPT code for diagnostic lumbar puncture. The provider requests the patient to sleep in a fetal position with his knees tucked to the chest while a needle is inserted in the lower back to draw out cerebrospinal fluid (CSF) for examination. The sample of CSF is later tested for meningitis (an infection that causes inflammation in the protective membranes of the brain and spinal cord).
CPT Code 62272 – Therapeutic Lumbar Puncture
Another neurology CPT code that is frequently used to report a lumbar puncture is 62272. However, unlike the code above, 62272 explains that a spinal tap was performed for therapeutic reasons. The provider inserts a hollow catheter or needle into the lower back of the spinal column (subarachnoid space) to suck out some cerebrospinal fluid (CSF) and reduce the pressure on the brain (intracranial pressure).
Excess CSF enlarges the brain’s ventricles and exerts pressure on the tissues, causing severe brain damage. Hence, it is vital to remove excess CSF and prevent cognitive impairment or worse – Fatality!
Neurology CPT Codes for Nerve Conduction Tests
Nerve conduction tests or studies (NCS) assess possible nerve damage. The healthcare provider places two electrodes on the patient’s nerve (mainly on the wrist or arm) to measure the speed of electrical impulses inside the nerves. One electrode stimulates the nerve by sending mild electrical impulses while the other records the nerve response or speed.
Providers can use nerve conduction tests to diagnose a range of neurological conditions like carpal tunnel syndrome, Guillain-Barré syndrome, sciatic nerve, or Bell’s palsy. The following CPT codes for neurology report nerve condition tests for up to 10 readings.
CPT Code 95910 – Nerve Conduction Test 7-8 Studies
This neurology CPT code is reported when the neurologist performs a nerve conduction study to assess the nerve’s electrical conduction ability. The provider takes 7 to 8 readings from the electrodes to determine if the motor and sensory nerves can send electrical signals at the correct pace.
Note that in normal adults, the average nerve conduction velocity is between 50 and 70 meters per second (m/s).
CPT Code 95911 – Nerve Conduction Test 9-10 Studies
Like the code above, neurology CPT code 95911 also reports a nerve conduction test. However, this time, the provider takes 9 to 10 readings for greater accuracy.
Neurology CPT Codes for Sleep Medicine Testing & Long-term EEG Procedures
Between 50 and 70 million Americans are living with sleep disorders like insomnia, obstructive sleep apnea, narcolepsy, and restless leg syndrome. This affects their quality of sleep, leading to reduced cognitive performance during the day.
Sleep studies and long-term EEG procedures monitor the patient’s brain activity and other bodily functions (such as breathing) while asleep. These tests help the neurologist diagnose sleep disorders for effective treatment and management. Below, we have explained the three most reported neurology CPT codes for sleep medicine testing and long-term EEG.
CPT Code 95720 – EEG PHY/QHP Each Increase with VEEG
This neurology CPT code reports long-term or continuous electroencephalography (with video) for up to 26 hours. Electrodes are placed on the patient’s scalp and connected to an EEG machine for brain activity monitoring. The neurologist obtains the results in the form of a video, analyzes the spikes (periods of increased brain activity), interprets the findings, and prepares a report after 24 hours of sleep monitoring.
You should report this neurology CPT code in 12-hour increments.
CPT Code 95806 – Sleep Study Unattended & Respiratory Effort
You should use this neurology CPT code when the sleep study measures several parameters to diagnose a sleep disorder. However, the technician is not present in the room while the patient sleeps, and his brain activity, breathing, and other parameters are being recorded.
CPT Code 95810 – Polysomnography for At Least 6 Hours, Additional Parameters
Another frequently used CPT code for neurology procedures is 95810. This code indicates that the provider performed continuous polysomnography (sleep study) for six or more hours to monitor and record the patient’s physiological and pathophysiological parameters related to sleep, such as brainwave activity, eye movement, heart rate, blood pressure, body temperature, etc. Again, the purpose is to detect sleep disorders.
Neurology CPT Codes for Electromyography (EMG) Procedures
Electromyography (EMG) is a diagnostic test that measures the electrical activity of the muscle in response to a nerve stimulation. Neurologists perform the EMG tests to diagnose neuromuscular disorders (muscle weakness) like multiple sclerosis, myasthenia gravis, and amyotrophic lateral sclerosis (ALS).
The most reported neurology CPT code for EMG testing is 95886, as explained below.
CPT Code 95886 – Needle EMG Each Extremity with Paraspinal Area Complete
In 2021, this neurology CPT code made up 14% of all the neurology and neuromuscular procedures reported countrywide. Not much has changed since then. Even today, it is widely used to bill electromyography of five or more muscles that are innervated by three or more nerves or four or more spinal levels. The EMG helps the neurologist assess the peripheral nervous system’s proper functioning.
Neurology CPT code 95886 is reported with a separately billable nerve conduction study. After assessing the electrical activity inside a nerve, the provider measures electrical conduction in a muscle in the extremities and paraspinal area.
CPT Codes for Neurology – A Summary
Choosing the most specific CPT code from over 130 neurology CPT codes can be challenging, especially if you are short on time and can hardly keep up with long and often similar code descriptors.
However, the process can be simplified if you know which category the service you rendered to your patient belongs to and can locate the most appropriate code from within the specified neurology CPT code range. Below, we have given you a summary of all the CPT codes for neurology and neuromuscular procedures.
| Neurology CPT Code Range | Category |
|---|---|
| 95700-95811 | Sleep Medicine Testing and Long-term EEG Procedures |
| 95812-95830 | Routine Electroencephalography (EEG) Procedures |
| 95829-95836 | Electrocorticography |
| 95836-95857 | Range of Motion Testing |
| 95860-95872 | Electromyography Procedures |
| 95873-95887 | Ischemic Muscle Testing Procedures and Guidance Procedures for Chemodenervation |
| 95905-95913 | Nerve Conduction Tests |
| 95919-95924 | Autonomic Function Testing Procedures |
| 95925-95941 | Evoked Potentials and Reflex Testing Procedures |
| 95940-95941 | Intraoperative Neurophysiology Procedures |
| 95954-95726 | Special EEG Testing Procedures |
| 95970-95984 | Neurostimulators Analysis-Programming Procedures |
| 95990-95999 | Other Neurology and Neuromuscular Procedures |
| 96000-96004 | Motion Analysis Procedures |
| 96020-96020 | Functional Brain Mapping |
Source: AAPC
As shown in the table above, neurology CPT codes 95700 to 96020 cover several diagnostic tests, analyses, brain mapping, and guidance procedures to detect neurological disorders and assess the nervous system’s performance.
Neurology Coding Guidelines
We may have simplified your search by uncovering this year’s 10 most used neurology CPT codes. However, you must adopt coding best practices to ensure accurate usage of these codes and submit clean and compliant insurance claims for your carefully rendered neurology procedures and services. If you are wondering what these best practices are, consider these neurology coding guidelines to get your claims approved on the first attempt.
Avoid Diagnosis and Procedure Code Mismatch
First and foremost, ensure that your ICD-10 diagnosis codes perfectly corroborate your CPT codes. We understand that neurological conditions and their treatment methods are complex and often nuanced. Sometimes, two or more codes describe the same condition and procedure. However, you must use the diagnostic and procedural codes most specific to the condition and situation.
Stay Up-to-Date with Revisions in the Coding Systems
The American Medical Association (AMA) revises CPT code sets annually, whereas ICD-10 codes are revised twice a year (in April and October). You must stay current with these revisions to avoid using deleted or incorrect codes.
Ensure Complete and Accurate Documentation
Insurance payers want to see supporting documents that justify the medical necessity of a procedure. Maintain detailed documentation, like the patient’s complete medical record, clinical notes, referral letters, and test reports, and submit it with the claim form as evidence.
Use Time-Based Coding for Analysis and Programming
For neurostimulator analysis and programming procedures (CPT codes 95970, 95983, and 95984), use time-based coding to report 1 unit of service when the provider-patient face-to-face contact exceeds 8 minutes. Refer to the table below for details.
| Physician or Other Qualified Health Care Professional Face-to-Face Time for Brain Neurostimulator Analysis with Programming | Code(s) |
|---|---|
| Less than 8 minutes | Not Reported |
| 8-22 minutes | 95983 x 1 |
| 23-37 minutes | 95983 x 1 + 95984 x 1 |
| 38-52 minutes | 95983 x 1 + 95984 x 2 |
| 53-67 minutes | 95983 x 1 + 95984 x 3 |
| 68 minutes or longer | Add units of 95984 |
Report Electrocorticography Results and Interpretation Once A Month
Electrocorticography (ECoG) procedures, e.g., code 95836, should be reported only once in 30 days as it denotes the review and interpretation of stored data remotely obtained from a chronically implanted electrode in the brain. Moreover, you must document the exact dates within the 30-day period for accurate reimbursement.
Append Modifiers when Required
Modifiers provide additional information to insurance payers about a procedure and its circumstances. When needed, use the appropriate pricing, payment, and location modifiers to get your rightful reimbursements. Modifiers that are usually appended with neurology CPT codes include 25, 26, 39, and 59.
Conclusion
Now that you are familiar with the top 10 CPT codes for neurology and neuromuscular procedures and understand the coding best practices, we hope you will use this information to improve your clean claim submission rate.
However, most neurology practices prefer to outsource CPT coding to professionals like MediBillMD. Their comprehensive neurology billing services include diagnostic and procedural coding in the competent hands of AAPC-certified professional coders.
