About 35% of neurology claims get denied on the first try, mainly due to coding errors and incomplete documentation. For a small practice, these billing mistakes can seriously hurt revenue. Also, the 2025 updates to neurology CPT codes, telehealth policies, and documentation rules have made accurate billing more critical than ever.
In this blog, we’ll cover neurology CPT codes, billing guidelines, and documentation requirements. Whether you’re a practice administrator or neurologist, you’ll learn these strategies. This will help you reduce denials, increase reimbursements, and stay compliant with the latest CMS and AMA regulations.
Common Neurology CPT Codes
Neurology practices use a wide range of CPT codes depending on the services provided. Understanding these codes is essential for accurate Neurology billing and proper reimbursement. Below are the most commonly used neurology CPT codes organized by procedure type.
Evaluation & Management (E/M) Codes
E/M codes describe office visits, consultations, and other outpatient services provided by neurologists. The code selection depends on the complexity of medical decision-making and the time spent with the patient.
| CPT Code | Description | Typical Use |
|---|---|---|
| 99202–99205 | New patient office visits | First-time patient evaluations |
| 99211–99215 | Established patient office visits | Follow-up visits for existing patients |
| 99242–99245 | Office consultations | Specialist consultations requested by another physician |
Electroencephalography (EEG) Codes
EEG procedures monitor brain electrical activity to diagnose conditions like epilepsy, seizures, and sleep disorders. Recent updates introduced significant changes to EEG coding, replacing older codes with more specific options.
| CPT Code | Description | Duration |
|---|---|---|
| 95816 | EEG awake and drowsy | 20–40 minutes |
| 95819 | EEG awake and asleep | 41–60 minutes |
Electromyography (EMG) and Nerve Conduction Studies (NCS)
EMG and NCS are diagnostic tests that assess muscle and nerve function using electrical currents. These procedures help diagnose conditions like neuropathy, myopathy, and radiculopathy.
EMG Codes:
| CPT Code Range | Description |
|---|---|
| 95860–95864 | Needle EMG for different muscle groups |
| 95885 | Needle EMG, each extremity with related paraspinal areas |
Nerve Conduction Study Codes:
| CPT Code Range | Description |
|---|---|
| 95907–95913 | Single and multiple nerve conduction studies |
| 95910 | Nerve conduction studies, 7–8 studies |
| 95911 | Nerve conduction studies, 9–10 studies |
Other Common Neurology Procedures
Lumbar Puncture (Spinal Tap):
| CPT Code | Description |
|---|---|
| 62270 | Diagnostic lumbar puncture |
| 62272 | Therapeutic lumbar puncture for drainage |
Neurostimulator Procedures:
The 2025 updates include new CPT codes for deep brain stimulation (DBS) programming and management, reflecting the growing use of these procedures for Parkinson’s disease and essential tremor. Common codes include 95970, 95983, and 95984 for neurostimulator analysis and programming.
Documentation Requirements
Your documentation determines whether you get paid. Even with perfect CPT codes, weak clinical notes will get your claims denied. Payers scrutinize neurology documentation more than most specialties because of the high-cost procedures involved.
Medical Necessity Documentation
Insurance companies won’t pay unless you prove the service was medically necessary. This means showing why the patient needed that specific test or procedure at that specific time. Vague notes like “patient needs EEG” won’t cut it.
Your notes need to tell the story. What symptoms is the patient experiencing? What treatments have you already tried? How will this test change your approach to their care? Missing any of these pieces gives payers an easy reason to deny.
What to Include in Clinical Notes
Your clinical notes need specific elements to support your codes. Skip one, and you’re looking at a denial or downcoded claim.
| Element | What to Document | Example |
|---|---|---|
| Patient History | Chief complaint, symptoms duration, previous treatments | “Patient reports 3 tonic-clonic seizures in past month despite levetiracetam therapy” |
| Physical Examination | Neurological findings, assessment results | “Decreased sensation in right lower extremity, positive Babinski sign” |
| Medical Decision-Making | Diagnosis reasoning, treatment plan, complexity level | “Given intractable seizures, ordering extended EEG monitoring to assess for surgical candidacy” |
| Laterality | Specify left, right, or bilateral for all relevant conditions | “Left-sided hemiparesis following stroke” |
| Severity & Frequency | Document intensity, how often symptoms occur | “Migraines occurring 15+ days per month, severity 8/10” |
Documentation Requirements
Neurology claims face heavier scrutiny because procedures are expensive and complex. Here’s what payers look for in different conditions.
Critical Documentation Points:
- For Epilepsy/Seizures: Write down the seizure type, how often they happen, how long they last, and whether medications are working. Always note if seizures are controlled or intractable.
- For Stroke Patients: Specify which side is affected, what areas of the brain are involved, and include the NIHSS score if you have it. Mention any history of previous strokes or TIAs.
- For Movement Disorders: Note which side has the tremor, how often it happens, how it affects daily life, and what medications you’ve tried.
- For Diagnostic Tests: Don’t just order a test—explain what you’re trying to find out and how it will affect treatment. Generic reasons get denied.
Time-Based vs. Complexity-Based Coding Documentation
Some codes care about how complex the visit was. Others care about how long you spent. Knowing which is which matters for documentation.
Complexity-Based Coding
Most office visits use medical decision-making complexity. Your notes should show how many problems you’re managing, what data you reviewed, and the risk level involved in your decisions.
Time-Based Coding
Certain neurology procedures bill by time. You need to write down exact start and end times, including how much of that was face-to-face with the patient.
Procedures Requiring Time Documentation:
| Procedure Type | Documentation Requirement |
|---|---|
| Neurostimulator Programming (95970, 95983, 95984) | Document face-to-face time; report one unit when time exceeds 8 minutes |
| Prolonged E/M Services (99417) | Total time must meet or exceed 15 minutes beyond base E/M code |
| Telehealth Services | Document total encounter time and platform used |
| Chronic Care Management | Track and document non-face-to-face time spent coordinating care |
Writing “spent significant time with patient” doesn’t work. Payers want actual minutes and what you did during that time.
Billing Guidelines
Getting the codes right is only half the battle. How you bill those codes determines whether claims get paid or denied. Here are the billing rules that cause the most problems.
When to Use Consultation vs. Office Visit Codes
Consultation codes (99242-99245) have strict requirements. Medicare and many commercial payers don’t even recognize them anymore. You need three things for a true consultation: a written request from another physician, your documented opinion, and a report sent back to the requesting provider.
Modifier Usage in Neurology Billing
Modifiers tell payers key details about your services. Missing or wrong modifiers cause denials.
Essential Neurology Modifiers:
| Modifier | When to Use |
|---|---|
| 25 | E/M service same day as procedure, must be separately identifiable |
| 59 | Procedure is distinct from another service on the same day |
| 50 | Procedure performed bilaterally |
| 26 | Professional component only (your interpretation) |
| TC | Technical component only (equipment and staff) |
| 95 | Telehealth via audio-video |
| 93 | Audio-only telehealth |
Initial vs. Subsequent Visit Coding
New patient codes (99202-99205) apply when the patient hasn’t seen you or anyone in your practice with the same specialty in three years. Otherwise, it’s an established patient (99211-99215).
Bundling and Unbundling Rules
The National Correct Coding Initiative (NCCI) sets strict rules about which procedures can be billed together. Bundled procedures are already included in the primary code’s payment.
Common Bundling Issues:
| What You’re Billing | The Fix |
|---|---|
| EMG with nerve conduction studies | Document they assessed different aspects; follow Appendix J limits |
| E/M with procedure same day | Add modifier 25 with documentation showing separate service |
| Bilateral procedure | Add modifier 50 and document both sides |
Check NCCI edits before billing procedures together, they update quarterly. Your documentation must clearly show why procedures billed together are separate and medically necessary.
Telehealth & Remote Monitoring Codes
Virtual Neurology Consultation Codes
Medicare rejected the new CPT telehealth codes (98000-98015) for 2025. Instead, you need to use standard office visit codes with the right modifiers and place of service.
How to Code Telehealth Visits:
| Service Type | CPT Code | Modifier | Place of Service |
|---|---|---|---|
| Video visit (new patient) | 99202–99205 | 95 | POS 02 (not at home) or POS 10 (at home) |
| Video visit (established patient) | 99211–99215 | 95 | POS 02 (not at home) or POS 10 (at home) |
| Audio-only visit | 99211–99215 | 93 | POS 02 or POS 10 |
| Brief virtual check-in (5–10 minutes) | 98016 | None | N/A |
Remote Patient Monitoring Codes
Remote monitoring lets you track neurology patients between visits. These codes cover device setup, data collection, and monitoring time.
Remote Monitoring Code Options:
| CPT Code | Description | Typical Use in Neurology |
|---|---|---|
| 99453 | Initial setup and patient education for remote monitoring device | Setting up seizure monitoring device |
| 99454 | Device supply with daily recording or programmed alerts | 16+ days of continuous monitoring per month |
| 98975-98978 | Remote therapeutic monitoring | Cognitive behavioral therapy for neurological conditions |
| 98978 | Remote therapeutic monitoring specifically for neurological conditions | Tracking medication adherence, symptom patterns in epilepsy or migraines |
You can bill these codes monthly when you meet the minimum time and data collection requirements. Code 99454 requires at least 16 days of data transmission per 30-day period.
Audio-Only vs. Video Visit Coding
Audio-only services are permanently allowed for behavioral and mental health services. For other neurology services, use audio-only only when the patient lacks video capability or declines video.
Modifier Requirements:
| Visit Type | Required Modifier | When to Use |
|---|---|---|
| Audio-video telehealth | 95 | Standard for most telehealth visits |
| Audio-only telehealth | 93 | Patient lacks video technology or declines video use |
Place of Service Codes:
- POS 02: Patient is NOT in their home during telehealth service
- POS 10: Patient IS in their home during telehealth service
Always document why audio-only was used instead of video for non-behavioral health services. Most payers expect video as the default and audio as the exception.
Conclusion
With the right knowledge of CPT codes, documentation requirements, and billing guidelines, you can reduce denials and improve your practice’s revenue. The 2025 updates bring changes, but they also create opportunities for practices that stay informed and adapt quickly.
Focus on documentation quality, use modifiers correctly, and stay up to date with telehealth coding rules. These three areas prevent most billing errors. When you consistently get the basics right, your claims get paid faster, and your staff spends less time fighting denials. Start implementing these strategies today to protect your practice revenue.
