How much does Medicare pay for CPT 95868?

Medicare allowed an average of $61.36 per service and paid $48.83 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1605.84, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95868?

Needle measurement of electrical activity in muscles on both sides of body. It was billed 4,571 times to 4,517 Medicare beneficiaries by 80 providers in 2024.

Does 95868 pay differently in an office than a hospital?

Yes. The allowed amount averaged $74.59 in an office setting and $59.86 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 95868 most?

Neurology, with 3,161 services from 68 clinicians. Next are Physical Medicine and Rehabilitation, Independent Diagnostic Testing Facility (IDTF), Audiologist.

CPT 95868

Needle measurement of electrical activity in muscles on both sides of body

$61.36Medicare-allowed amount per service, averaged across 4,571 services

Providers submitted

$1605.84

Asking price, not received

Medicare allowed

$61.36

The fee schedule figure

Medicare paid

$48.83

Balance is patient coinsurance

Providers submitted an average of $1605.84 for this code and Medicare allowed $61.36 — 26.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $48.83 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $74.59
Hospital / facility: $59.86

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 467 services were billed in an office setting and 4,104 in a facility.

Services: 4,571
Beneficiaries: 4,517
Providers billing it: 80
Total allowed: $280,477

What Medicare pays for CPT 95868

Across 4,571 services billed by 80 providers to 4,517 beneficiaries, Medicare allowed an average of $61.36 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 95868

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurology	3,161	3,141	$60.60	68
Physical Medicine and Rehabilitation	803	791	$56.92	7
Independent Diagnostic Testing Facility (IDTF)	438	432	$71.52	1
Audiologist	108	107	$58.86	1
Otolaryngology	29	14	$121.03	1
Anesthesiology	19	19	$64.93	1
Hospitalist	13	13	$63.19	1

95868 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	1,796	$62.59	$50.67	21
Nevada	444	$61.45	$47.59	4
California	304	$62.98	$47.43	7
Florida	295	$61.73	$47.59	7
Louisiana	284	$53.81	$47.61	3
Arizona	210	$59.53	$47.63	1
North Carolina	198	$60.68	$47.56	5
Georgia	115	$56.12	$47.51	2
Utah	108	$58.86	$47.64	1
New Jersey	104	$63.30	$47.18	5
Puerto Rico	96	$57.02	$47.61	1
Colorado	88	$61.92	$47.54	3
Ohio	87	$58.38	$47.69	3
Arkansas	75	$56.18	$47.57	1
Oklahoma	55	$53.23	$47.62	1
Massachusetts	48	$64.99	$47.56	2
New York	47	$68.52	$46.60	2
Kansas	45	$58.64	$47.60	2
Pennsylvania	39	$58.21	$47.61	2
Tennessee	30	$65.87	$47.53	1
Kentucky	29	$121.03	$108.30	1
Michigan	21	$57.47	$47.71	1
AE	16	$60.59	$47.66	1
Virginia	15	$59.24	$47.71	1
Delaware	11	$59.78	$47.54	1
Minnesota	11	$59.29	$47.76	1

Related codes

95886Needle measurement of electrical activity in arm or leg muscles$86.76
95816Measurement of brain wave activity (eeg)$227.96
95811Sleep study in sleep lab$314.61
95810Sleep study in sleep lab (6 years or older)$309.74
95800Sleep study including heart rate$117.17
95819Measurement of brain wave activity (eeg)$239.95
95885Needle measurement of electrical activity in arm or leg muscles$46.74
95806Sleep study including heart rate$54.06
95874Needle measurement of electrical activity in muscle$53.46
95861Needle measurement of electrical activity in arm or leg muscles$80.08
95870Needle measurement of electrical activity in arm$19.70
95813Measurement of brain wave activity (eeg)$202.49

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.