CPT Codes in Neurology Billing: A Comprehensive Guide 

Neurology is a complex field, and so is its billing. From EEGs to Botox injections for migraines, every procedure has its own CPT code, documentation rules, and payer guidelines. If you don’t bill it right, it gets denied. It’s as simple as that. 

Billing for neurology services can feel like decoding a secret language, full of numbers, rules, and modifiers. Whether you’re a billing professional, neurologist, or office manager, understanding CPT codes in neurology is essential for clean claims, timely payments, and avoiding neurology coding audits. 

This guide is here to help you: 

• Understand which neurology CPT codes to use 
• Bill correctly for office visits, diagnostic tests, procedures, and telehealth 
• Avoid common (and costly) billing mistakes 

Understanding CPT Codes in Neurology 

CPT (Current Procedural Terminology) codes are five-digit numeric codes maintained by the American Medical Association (AMA). These codes describe the “what”—in other words, what service or procedure the provider performed during a patient encounter. 

Think of them as the billing language that connects the care provided with neurology reimbursement. Even if the provider delivered outstanding clinical care, it doesn’t get paid if it’s not coded. 

CPT Codes in Neurology 

In a neurology practice, CPT codes may describe a wide variety of services: 

• A patient visit to evaluate recurring migraines may involve a 20-minute consult or a comprehensive workup with an imaging review. This falls under E/M codes (99202–99215). 
• An EEG (electroencephalogram) is used to diagnose or monitor conditions like epilepsy. You might bill 95816 for a routine EEG or code based on duration or complexity. 
• An EMG (electromyography) is used to assess nerve and muscle function, such as in a patient with suspected carpal tunnel syndrome. Codes like 95860 or 95909 are used. 
• A Botox injection to treat chronic migraines under code 64615, paired with a drug code like J0585 to reflect the medication used. 

Each service has a specific neurology  CPT code, and each code has its own rules for documentation, modifiers, and medical necessity. 

CPT + ICD-10 = Clean Claims 

Choosing a CPT code and applying it to the claim is not enough. Each CPT code must be justified with a relevant ICD-10 diagnosis code that explains why the service was medically necessary. 

Here’s how you can think about it: 

• CPT code = What was done 
• ICD-10 code = Why it was done 

For example, a physician evaluates a patient with chronic migraines: 

• CPT: 99214 – Established patient E/M visit (moderate complexity) 
• ICD-10: G43.709 – Chronic migraine without aura, not intractable 

Or maybe the visit included a Botox injection: 

• CPT: 64615 – Chemodenervation of muscles innervated by facial, trigeminal, and cervical spinal nerves (for migraine treatment) 
• ICD-10: G43.711 
• – Chronic migraine without aura, intractable, with status migrainosus 

The CPT and ICD-10 codes must match logically. If the diagnosis doesn’t support the service (e.g., billing an EMG for a headache), the payer will likely deny the claim or request more documentation. 

Why CPT Accuracy Matters in Neurology 

Neurology covers procedural care (EEGs, EMGs, injections) and cognitive care (complex diagnoses, lengthy consultations). That means billing accuracy is vital for revenue integrity and compliance. 

Here are a few reasons why: 

• Neurology services are often of higher complexity and more expensive, drawing closer scrutiny from payers. 
• Many services are subject to prior authorization, and the CPT code triggers that need. 
• Mistakes in CPT coding can increase audit risk, particularly for procedures such as Botox injections, psychological testing, or diagnostic studies. 

Key Neurology CPT Codes and How to Bill Them 

Billing in neurology isn’t just about picking codes from a list—it’s about understanding what was done, how it was done, and why it matters. Let’s break down the most frequently used CPT codes in neurology and how to bill them properly, using practical scenarios to bring each category to life. 

Evaluation and Management (E/M) Codes in Neurology

These are your bread-and-butter codes for patient visits — whether someone’s coming in with migraines, seizures, neuropathy, or memory loss. 

CPT Breakdown: 

• 99202–99205: For new patients 
• 99212–99215: For established patients 

How Do You Choose the Right Level? 

Two main criteria: 

• Medical Decision-Making (MDM): Was the case straightforward (one simple diagnosis) or complex (multiple issues, high risk, coordination of care)? 
• Time Spent: Total time spent on the day of the visit, including review of records, charting, and talking with the patient/family. 

For example, a neurologist spends 35 minutes with a patient reviewing an MRI, discussing MS treatment options, and documenting everything in the EHR. This can qualify for 99214 under time-based coding. 

Use Modifier 25 when you’re billing an E/M visit and a procedure on the same day, and the visit is separately identifiable from the procedure. 

In another scenario, a patient presents for a migraine consultation. The neurologist performs an exam (billed as 99213) and administers Botox injections (64615). You must add Modifier 25 to the E/M code to indicate that the visit wasn’t solely for the procedure. 

Neurology Diagnostic Testing Codes 

This is where things get highly specialized, and billing errors are common if you’re not careful with modifiers, documentation, and payer rules. 

EEG Codes (Electroencephalogram) 

As a neurologist, you will use ECG codes to diagnose seizure disorders, monitor brain activity, or evaluate altered mental status. 

These codes include

• 95812 – EEG, 41–60 minutes 
• 95816 – Routine EEG (awake and drowsy) 
• 95819 – Routine EEG (awake and asleep) 

A patient with suspected epilepsy undergoes a 60-minute awake EEG. 
You bill 95816, and: 

• If your neurologist reads the test only → Modifier 26 
• If your clinic owns the equipment and performs the test →, Modifier TC 
• If both professional and technical components were performed → Bill the code without modifiers 

EMG & NCV Studies (Electromyography and Nerve Conduction Velocity) 

These codes assess muscle and nerve function — think carpal tunnel, radiculopathy, or neuropathy. 

• 95860–95870 – EMG studies 
• 95907–95913 – NCV studies (1–6+ studies) 
• If your neurologist is performing and interpreting → Bill globally (no modifier) 
• If interpretation only → Use Modifier 26 
• If you’re providing the equipment or space, → Use Modifier TC 

A patient with peripheral neuropathy gets a 4-limb EMG with 3 NCV studies. You’ll likely bill 95864 for the EMG and 95909 for the NCV. Append modifiers accordingly. 

Evoked Potentials 

These tests assess brain responses to stimuli such as light, sound, or touch, often used in diagnosing MS. 

• 95925–95939 – Visual, brainstem, and somatosensory evoked potentials 

You must document: 

• Stimulus modality 
• Time spent 
• Interpretation details 
• Whether TC/26 applies 

 Procedures and Interventions Codes in Neurology

From spinal injections to Botox, neurology is full of hands-on procedures.  

• Botox for Migraines (Chemodenervation): 64615 – Chemodenervation of muscles for chronic migraine 

A patient receives Botox every 12 weeks for chronic migraines. Bill: 

• 64615 for the injection procedure 
• J0585 for the actual botulinum toxin (document number of units and lot number) 

Don’t forget: 

• Diagnosis must match (e.g., G43.711 for chronic intractable migraine with status migrainosus) 
• Botox requires prior authorization for many plans 

 Other Neurology Procedures and their codes are: 

• 62321 – Epidural steroid injection (common in MS-related or radiculopathy pain) 
• 61790–61791 – Stereotactic brain procedures (e.g., for deep brain stimulation) 
• 62270 – Spinal tap/lumbar puncture 

Include clinical indication (e.g., rule out meningitis, evaluate CSF in MS). Poor documentation = denied claims. 

Mental & Behavioral Health in Neurology 

Many neurologists encounter patients with cognitive or psychological complications from conditions like Parkinson’s, stroke, dementia, or MS. 

Commonly Used Codes: 

• 96116 – Neurobehavioral status exam (used during cognitive decline evals) 
• 96130–96133 – Psychological testing (used with testing instruments, scored and interpreted) 
• 90834 / 90837 – Psychotherapy codes for counseling during neurology follow-up 

You do a cognitive screen with 96116 and then follow up with a more extended therapy session using 90837. Add modifier 59 or 25 to indicate distinct services and document them. 

Many payers require prior authorization for neuropsych testing. Double-check.

Telehealth & Remote Monitoring Codes 

Neurology was one of the first specialties to adopt digital technology, particularly for follow-ups and managing chronic conditions. 

Remote Monitoring Codes in neurology are: 

• 99453 – Device setup and patient education 
• 99454 – Device supply and daily data transmission (30 days) 
• 99457 – 20 minutes of monitoring + communication with a patient 

Used for seizure monitoring, Parkinson’s symptoms, or even blood pressure tracking in stroke recovery. 

Virtual & Phone Visit Codes 

• 99441–99443 – Telephone E/M services (5–30 minutes) 

For example, a neurologist calls a patient for a 20-minute follow-up on headache management. Use 99442 with POS 02 and Modifier 95. 

Telehealth Documentation Must Include: 

• Patient consent for telehealth 
• Location of patient (POS 02 = provider facility; POS 10 = patient’s home) 
• Modifier 95 for synchronous visits (audio + video) 

Legal and Payer Requirements for Neurology Billing 

Every insurer has its own rules, and so does Medicare. 

As a neurologist, you must know: 

• Medical necessity: Always tie your CPT to a valid ICD-10 (e.g., G43.709 for migraine) 
• NCCI edits: Prevent you from billing incompatible services together 
• Global periods: If a neurosurgeon does a procedure with a 90-day global, you can’t bill an E/M visit for related complaints during that time 
• Medicaid quirks: Some states require prior auth for 96116 or EEGs — always check 

Common Neurology CPT Coding Mistakes 

Even the most experienced neurology billers and providers can fall into common coding traps. These errors can lead to claim denials, payment delays, or compliance investigations. 

Here’s what to watch for:

Billing 99215 without Solid Proof of Time or MDM 

99215 is the highest-level code for established patient visits, and payers love to audit it. 

Mistake: Billing 99215 for a routine follow-up with no documented complexity or time justification. 

How to Fix: 

To bill 99215 and fix errors, you need: 

• High-level MDM (e.g., multiple chronic conditions, new neuro symptoms, significant data review), or 
• 40–54 minutes of total time spent (face-to-face + non-face-to-face) 

Include start/stop times and describe what was done (e.g., “Reviewed three prior MRI scans, coordinated with PCP, updated seizure medication protocol”). 

Forgetting TC/26 Modifiers on EEG or EMG 

This one’s a super common mistake in neurology coding — and costly. 

Mistake: Billing complete professional and technical services when you only did the interpretation (or vice versa). 

How to Fix: 

Know which component you’re billing: 

• Modifier 26 = Professional component (interpretation/report only) 
• Modifier TC = Technical component (equipment, setup, technician) 

If you interpret an EEG recorded at a hospital lab, bill 95816-26 — is not the complete code.  

Skipping Modifier 25 When an E/M + Procedure Is Done 

This is a significant consideration for Botox or injection clinics. 

Mistake: You bill 99214 + 64615 on the same day, but don’t add Modifier 25 to the E/M code. 

How to Fix: 

• Use Modifier 25 on the E/M code when: 
• The visit involved a separately identifiable service 
• AND a procedure (like Botox, EMG, or spinal tap) was done on the same day 

Your note should clearly show that the E/M wasn’t just a prelude to the procedure. 

Not Appending Modifier 95 for Telehealth 

Yes, telehealth is here to stay — but the billing still trips people up. 

Mistake: You billed 99213 for a video visit but forgot to: 

• Use Modifier 95 
• Indicate POS 02 (telehealth) or POS 10 (home-based telehealth) 

How to Fix: 

• Add Modifier 95 for synchronous (real-time audio + video) visits 
• Use the correct Place of Service code based on where the patient is 

Without Modifier 95, the claim may be processed as an in-person visit and denied or underpaid. 

Billing 64615 for Botox but Forgetting the Drug Code (J0585) 

Think of it this way: No drug = no reimbursement for the injection. 

Mistake: You bill the procedure code (64615) for chemodenervation but forget to include the drug itself — J0585 (Botulinum toxin, per unit). 

How to Fix: 

Always pair: 

• 64615 – The injection procedure 
• J0585 – The actual botulinum toxin (make sure to document the number of units used, lot number, and NDC if required) 

Some payers require J0585 to be billed under the pharmacy benefit, not the medical benefit. Always verify.

• Want to Stay Error-Free?  Here’s a quick checklist to avoid these headaches: 
• Train staff regularly on CPT/ICD-10 pairing and modifier use 
• Use billing software or EHR alerts for high-risk codes (like 99215, 64615) 
• Perform monthly internal audits on EEGs, Botox, and E/M + procedure combos 
• Maintain payer-specific cheat sheets for telehealth and procedure billing 
• Document everything — assume the payer will question high-level codes 

Conclusion 

Mastering CPT codes in neurology isn’t about memorizing a list — it’s about understanding the logic behind each service, the documentation it requires, and how it connects to payer rules. 

Whether you’re billing for Botox, EMGs, or remote monitoring, accuracy = reimbursement. Clarity in documentation = peace of mind. 

Frequently Asked Questions (FAQs) 

What’s the difference between EMG and NCV codes? 

EMG tests muscle activity (95860–95870); NCV tests nerve conduction speed (95907–95913). They’re often billed together but documented separately. 

Can I bill for an EEG and a consultation on the same day? 

Yes — if medically necessary and separate. Use modifier 25 with the E/M. 

Do I need prior authorization for 96116 (neurobehavioral exam)? 

Possibly. Some Medicaid and commercial plans do. Always verify with the payer. 

How does POS affect telehealth neurology claims? 

It tells the insurer where care was provided. Use POS 02 for facility-based services and POS 10 for home-based telehealth services. 

What CPT code do I use for Botox for migraines? 

Use 64615 for the injection plus J0585 for the drug. Don’t forget to document units!