Specialty billing
Neurology Medical Billing Services
Neurology billing pairs complex, lengthy evaluation and management encounters with diagnostic testing — EEG, EMG, nerve conduction and sleep studies — that carry their own technical and professional splits and strict unit rules. Infusion therapies for multiple sclerosis and migraine add buy-and-bill drug billing on top.
Neurology benchmarks
- Typical denial rate
- 12–18%
- Days in AR
- 38–50
- Achievable clean claim rate
- 96%+
Typical ranges for neurology practices. Your actual numbers are measured during the audit.
The complexity
Why neurology is uniquely difficult to bill
Nerve conduction studies bill by the number of nerves tested, with payer caps
EMG and nerve conduction performed together follow specific combined-code rules
EEG and sleep studies split into technical and professional components
Infused biologics require buy-and-bill drug coding with correct units and wastage
Botulinum toxin injections require both the drug and the administration code
Prolonged E/M encounters are frequently under-coded relative to documented complexity
Coding
Neurology procedure codes we work with daily
A representative sample, not an exhaustive list. Coders are assigned by specialty rather than pooled.
| Code | Description |
|---|---|
| 95886 | Needle electromyography, complete, each extremity |
| 95910 | Nerve conduction studies, 7–8 studies |
| 95816 | Electroencephalogram, awake and drowsy |
| 95810 | Polysomnography, sleep staging with 4 or more parameters |
| 64615 | Chemodenervation of facial and neck muscles for chronic migraine |
| 96413 | Chemotherapy or complex drug infusion, first hour |
Revenue leakage
Where neurology practices lose money
These are the denial patterns specific to this specialty — the ones a general-purpose billing service will not be looking for.
Nerve conduction unit caps
Studies billed beyond the payer's maximum number of nerves per diagnosis without documented justification.
EMG and NCS combination rules
Separate codes billed where the payer requires the combined study code for same-session testing.
Drug units and wastage
Infused drug units miscalculated, or discarded drug not documented with the JW modifier where required.
Component splits on testing
Global billing for EEG or sleep studies performed at a facility the practice does not own.
Botulinum medical necessity
Chronic migraine injections denied where documentation does not establish headache frequency meeting payer criteria.
Payer landscape
What neurology practices need to know about payers
Payer policy drives more neurology denials than coding does. Knowing the policy before the service is what prevents them.
- Most payers publish maximum nerve conduction study counts per diagnosis; exceeding them requires documented justification.
- Botulinum toxin for chronic migraine requires documented headache days per month and prior treatment failures under most policies.
- Buy-and-bill infusion economics depend on accurate unit calculation — small errors compound across high drug costs.
Questions
Neurology billing FAQ
Last updated August 20, 2026
Reviewed by a certified coding leadBy the number of nerves studied, using code ranges that bracket study counts rather than one code per nerve. Most payers publish a maximum number of studies reimbursable per diagnosis. Exceeding that cap without documented clinical justification produces a denial regardless of what was clinically appropriate.
Usually unit calculation. Drug codes bill in specific unit increments that rarely match vial sizes, so the billed units must be computed from the dose administered rather than the vials opened. Discarded drug may be separately billable with the JW modifier when documented — and is frequently forfeited instead.
Yes. Both have technical and professional components. If the study is performed in a facility the practice does not own, only the professional interpretation is billable with modifier 26. Practices operating their own sleep lab bill globally — but only for studies performed there.
Most payers require documented chronic migraine meeting a headache-days-per-month threshold, plus failure of a defined number of prior preventive medications. The drug and its administration are billed separately, and both deny if the underlying medical necessity documentation is incomplete.
Primary sources
Coverage, rates and local policy for neurology, at the source.
- Medicare Coverage Database (LCD/NCD) (opens in a new tab)
Centers for Medicare & Medicaid Services — Searchable national and local coverage determinations. The direct answer to whether a diagnosis supports medical necessity for a given procedure.
- Medically Unlikely Edits (MUE) tables (opens in a new tab)
Centers for Medicare & Medicaid Services — The maximum units of a code payable for one patient on one day. Unit-based denials usually trace to this table rather than to a coding error.
- Medicare Physician Fee Schedule lookup (opens in a new tab)
Centers for Medicare & Medicaid Services — Official allowed amounts by CPT/HCPCS code and locality. The reference point most commercial contracts are written against as a percentage.
Get a free neurology billing audit
We'll review your neurology denial patterns, coding accuracy and AR aging against the benchmarks above. Takes about two minutes to request.
No setup fees · You pay when we collect · Pricing from 3% of net collections