Billing Resources

Reimbursement

Data Management Ventures, Inc. conducts a nationwide survey among practitioners in the rehabilitative medicine field through an annual mail survey questionnaire. In October 2002, they reported the following dollar amounts charged for surface EMG (sample size 300, billing code 95999):

Surface EMG (one area, upper or lower spine, with interpretation and report)

• Average charged $ 75
• 20% charged $ 100 or more
• 10% charged $ 125 or more

Surface EMG (entire spine, with interpretation and report)

• Average charged $ 139
• 20% charged $ 200 or more
• 10% charged $ 225 or more

NOTE 1: These figures reflect the situation during the second half of 2002.
NOTE 2: A new survey was conducted in the fall of 2003. For other modalities and state specific information, please contact Data Management Ventures, Inc. (Tel. 770-592-7900, ask for “Fee Facts”).

CPT Codes

Some billing codes previously used for surface EMG were changed in 1995 and others were deleted or modified since then. Currently, there are several codes designated for surface EMG evaluation and therapy. Depending on the nature of each case, one of the following codes should suit your needs. We discourage you from using the needle EMG codes. Furthermore, regardless of the code you choose to use, always clearly specify that surface EMG was used.

The CPT codes listed below are from the American Medical Association, Current Procedural Terminology CPT 2003, Standard Edition © 2002.

CPT Codes Used in Conjunction with Surface EMG

Biofeedback

• 90901: Biofeedback training by modality
• 90911: Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry

Neurology and Neuromuscular Procedures

• 95999: Unlisted neurological or neuromuscular diagnostic procedure

Motion Analysis

• 96002: Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles
• 96003: Dynamic fine wire electromyography, during walking or other functional activities, 1 muscle
• 96004: Physician review and interpretation of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report

Physical Medicine and Rehabilitation

Therapeutic Procedures

• 97110: Therapeutic procedure, one or more areas, each 15 minutes; therapy
• 97112: Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception
• 97116: Gait training (includes stair-climbing)
• 97530: Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes
• 97750: Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes
• 97139: Unlisted therapeutic procedure (specify)

Urinary System

Urodynamics (Under direct supervision of a physician:)

• 51784: Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique

NOTE: Reimbursement varies among insurance carriers and different states. We encourage you to verify the current practices with local sources.

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