View Full Version : NEW EMG code 95886 denials

01-24-2012, 11:00 AM
is anyone else getting modifier 26 denials on these?


Medicare states that "Procedure modifier was invalid on the date of service" for CPT code 95886 billed with a modifier 26 (done in a facility outpatient setting), with 2 units. NCS codes were billed as primary procedures. Any idea why these might be denying? I've received several denials for these. Maybe I shouldn't use the 26 modifier because it's an add-on code? But we still don't own the equipment, so isn't a 26 modifier required?

02-06-2012, 09:29 AM
:(I have been getting denials too but not for the modifer and they are separating to expedite handling. So now they will have the NCS on a different EOB.. But my denial states incomplete/invalid from dates of service. Little Frustrated...

02-07-2012, 08:47 AM
I spoke to a Medicare representative from our jurisdiction (Alabama) who said that only 1 unit of 95886 could be billed per line. More than one unit could be billed, but only 1 per line.

I hope that helps.

02-16-2012, 12:23 PM
Yes, I am getting denials as well. I have been on several different sites trying to find an answer. Someone suggested the following.

95886 -26
95886 -59 -26

I have just billed a couple out like that. I will respond again as soon as I have denial or reimbursement.

Val Johnson, CPC
Practical Billing Solutions, PA

05-09-2012, 02:55 PM
Billing with 95886,26x2 got completely denied.
billing with 95886,26 and 95886,26,59 got the one with the 59 modifier paid, but the one without the 59 was denied. I rebilled with it 59s on both, which seems inappropriate to me, but whatever makes Medicare happy makes ME happy :). Incidentally, I checked with the facility and they're getting paid for thier portion with no problems. I find that frustrating.

05-10-2012, 12:53 PM
Well, we don't split bill our EMG's but I have gotten this paid qty x 2 by Medicare MI

Have found out that if you bill a 95885 & 95886 - you need mod 59 on 95885