Neurology diagnostics are coverage-controlled. EEG and video monitoring are paid by duration tier and clinical indication; EMG and nerve conduction studies are limited by the number of studies and limbs per encounter; and chemodenervation codes like 64615 carry site-count requirements and prior authorization in most plans. The billing question is never just which code — it is whether the documentation establishes the frequency and necessity the payer requires.
Start with EEG. Routine studies split into awake-and-drowsy (95816), awake-and-asleep (95819) and coma/non-convulsive monitoring (95822). Longer monitoring moves into the 95700–95726 video-EEG tiers, where payment steps up with duration and documentation must establish why extended monitoring was clinically required. Billing a higher duration tier than the record supports is the classic recoupment risk in neurology.
EMG and NCS are billed by study count. Nerve conduction codes 95907–95913 scale with the number of studies performed (1–2 through 13+), while needle EMG codes (95886, 95887) bill per limb with nonparaspinal versus other-designation rules. CMS NCCI policies govern how many units and which combinations are payable in one session — and commercial payers frequently layer their own frequency limits on top, revisiting whether repeat studies in the same quarter are medically necessary.
Chemodenervation for chronic migraine (64615) requires documentation of 31+ injection sites across specific muscle groups and, for most payers, prior authorization that must be renewed on the payer's cadence — not the patient's convenience. When authorization lapses mid-course, treatment continues but revenue stops. Our neurology workflow tracks auth expiration dates and re-files before the window closes, so injection schedules never outrun coverage.
“48% of leaders named denials and appeals their practice’s largest source of revenue leakage, compared with 23% who cited front-end issues.”