Neurology coding depends on precise EMG/NCS study counts, EEG documentation, and prior authorization for advanced imaging. This page covers the most frequently used FY2026 ICD-10-CM diagnosis codes and CPT 2026 procedure codes for neurologists and neurodiagnostic practices in the United States.
FY 2027 ICD-10-CM (CMS, eff. 10/1/2026) · CPT 2026 (AMA) · All codes verified billable · Last verified: October 2026
Unspecified dementia without behavioral disturbance
✓
G30.9
Alzheimer’s disease, unspecified
✓
R56.9
Unspecified convulsions
✓
R55
Syncope and collapse
✓
R42
Dizziness and giddiness
✓
G24.9
Dystonia, unspecified
✓
G25.0
Essential tremor
✓
G61.0
Guillain-Barre syndrome
✓
G70.00
Myasthenia gravis without (acute) exacerbation
✓
G81.90
Hemiplegia, unspecified, affecting unspecified side
✓
S06.0X0A
Concussion without loss of consciousness, initial encounter
✓
Common CPT Codes for Neurology Billing
CPT Code
Description
Medicare Rate*
Common Modifiers
99203
Office visit, new patient, low complexity
~$118
-25, -95, -GT
99214
Office visit, established patient, moderate/high complexity
~$136
-25, -95, -GT
95816
EEG, including recording, awake and drowsy
~$414
-26, -TC
95819
EEG, including recording, awake and asleep
~$482
-26, -TC
95860
Needle electromyography (EMG), one extremity
~$120
-59, -LT, -RT
95861
Needle EMG, two extremities
~$162
-59, -LT, -RT
95907
Nerve conduction studies (NCS), 1-2 studies
~$94
-59
95910
Nerve conduction studies (NCS), 7-8 studies
~$185
-59
95900
Nerve conduction, motor, without F-wave study, each nerve
~$38
-59
62270
Spinal puncture, lumbar, diagnostic
~$165
-59
70551
MRI brain, without contrast
~$195
-26, -TC
70553
MRI brain, without and with contrast
~$317
-26, -TC
96116
Neurobehavioral status exam, first hour
~$94
-59, -96
96132
Neuropsychological test evaluation, first hour
~$122
-59, -96
*Approximate 2026 CMS national non-facility rate. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates.
Top Denial Reasons for Neurology Claims
⚠
EEG/EMG Not Supported by Documented Exam Findings
Payers frequently deny diagnostic neurophysiology studies (EEG, EMG, NCS) when the chart lacks a documented neurological exam finding, symptom duration, or a failed conservative-management trial justifying the study.
⚠
Missing Extremity or Study Count on EMG/NCS Claims
EMG and NCS codes are tiered by the number of extremities or studies performed (95860 vs. 95861; 95907 vs. 95910). Claims without an itemized count of nerves or muscles tested in the report are downcoded or denied.
⚠
Prior Authorization Not Obtained for Advanced Imaging
Brain MRI (70551, 70553) routinely requires prior authorization from commercial and Medicare Advantage payers. Performing the scan without a valid, matching authorization number is a leading denial cause.
⚠
E&M and Diagnostic Study Billed Same Day Without Modifier -25
Billing an office visit E&M code alongside an EEG or EMG performed the same day, without modifier -25 and a clearly separate, documented E&M service, triggers bundling edits and denials.
Neurology Billing & Coding Tips
Document the specific extremities and the exact number of nerves or muscles tested for EMG/NCS claims — code selection (95860 vs. 95861; 95907 vs. 95910) depends entirely on this count and is the first thing auditors check.
Confirm prior authorization for brain MRI and extended EEG monitoring before scheduling; many payers require peer-to-peer review for non-emergent advanced neuro-imaging.
Use modifier -25 only when a significant, separately identifiable E&M service is documented apart from the diagnostic study performed at the same visit.
Code chronic neurological conditions (Parkinson’s G20, MS G35, epilepsy G40.x) with full specificity, including intractability and status — unspecified-status codes without ongoing supporting documentation are increasingly flagged for review.
What is the difference between CPT 95860 and 95861?
95860 is a needle EMG of one extremity, with or without related paraspinal muscles. 95861 covers two extremities. Code selection depends on the documented number of extremities tested, not the number of muscles within a single limb.
When should NCS codes 95907 vs. 95910 be used?
These are tiered by the number of nerve conduction studies performed per encounter: 95907 covers 1-2 studies, 95910 covers 7-8 studies. The exact study count must be itemized in the report to support the tier billed.
Does insurance require prior authorization for a brain MRI?
Most commercial and Medicare Advantage plans require prior authorization for non-emergent brain MRI (70551/70553). Confirm authorization before scheduling to avoid a preventable denial.
What ICD-10 code is used for migraine with aura?
G43.109 (migraine with aura, not intractable) is billed when aura symptoms are documented; use G43.909 for migraine without aura. Add the appropriate 6th character for intractability and status migrainosus when documented in the chart.
How does OmniMD support neurology coding?
OmniMD’s Neurology EHR includes structured templates for EEG, EMG, and NCS reporting that suggest ICD-10 and CPT pairings based on documented findings, reducing downcoding and prior-authorization delays.
Streamline Your Neurology Practice with OmniMD
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