EMG Guidance Billing Codes
EMG Guided Injection – CPT Codes
The Myoguide system is designed to amplify EMG signals from muscle and provide audio feedback to assist clinicians in locating areas of muscle activity.
Myoguide also has an integrated and well featured stimulator, capable of stimulation in either 1.0 mA or 0.1 mA steps. Clinicians can see and hear EMG activity, as well as challenge sites of interest with stimulation pulses, that can be characterized by a wide range of options.
Myoguide supports injection of neuromodulators and both chemodenervation and neurolytic procedures.
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Insurance – Guided Injection – CPT Codes (updated 2014)
There are three procedures for Myoguide; one for the EMG, one for stimulation location, and one for the injection:
To account for the EMG guidance use the CPT code listed below in addition to the CPT code for the injection. +95874 >>Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)
To account for the guidance using electrical stimulation use the CPT code listed below in addition to the CPT code for the injection. +95873. Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)
• Modifiers include “-TC” for technical component only; “-26” (professional component alone) for the situation where clinician does not own their EMG machine; Interesting enough it seems like in some jurisdictions if you do not own the EMG machine billing drops to 1/3 the full fee.
If the injection is of local anesthetic and/or steroid the CPT codes are 20552 for injections of one or two muscle, and 20553 for injections of three or more muscles.
If the injection is of a chemical neurolytic agent such as botulinum toxin, or phenoxybenzamine:
In addition to coding for the procedure, physicians should also code for the drug itself. Supply codes for the two types of botulinum toxin currently in clinical use: J0585 Botulinum toxin type A (Botox© and Dysport©), per unit; J0588 Botulinum toxin type A (Xeomin©), per unit; J0587 Botulinum toxin type B (Myobloc©), per 100 units.
Six new codes for chemodenervation of extremities have been added for 2014:
• 64642: chemodenervation of 1 extremity; 1–4 muscle(s)
• 64643: chemodenervation of 1 extremity; each additional extremity, 1–4 muscle(s) (List separately in addition to code for primary procedure)
• 64644: chemodenervation of 1 extremity; 5 or more muscle(s)
• 64645: chemodenervation of 1 extremity; each additional extremity, 5 or more muscle(s) (List separately in addition to code for primary procedure)
• 64646: chemodenervation of trunk muscle(s); 1–5 muscle(s)
• 64647: chemodenervation of trunk muscle(s); 6 or more muscle(s)
Code 64614, which was intended to describe multiple uses of chemodenervation of extremity (or extremities) and/or trunk muscle(s), has been deleted because it lacked specificity. Codes 64642–64647 allow more specificity and are used to report chemodenervation of extremity and trunk muscles. Codes 64642–64645 are specifically intended to report chemodenervation of extremity, 1–4 muscles, and 5 or more muscles. Codes 64646 and 64647 are specifically intended to report chemodenervation of trunk, 1–5 muscles, and 6 or more muscles. Trunk muscles include erector spinae, obliques, paraspinal, and rectus abdominus. Other muscles are considered neck, head, or extremity muscles.
Codes 64642–64645 are reported once per extremity; up to a total of 4 units may be reported per patient, if all extremities are injected. As such, codes 64642 or 64644 may only be reported once per session and additional extremities are reported with codes 64643 or 64645.
Modifiers:
25 – Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service
50 – Bilateral procedure (Do not report codes 64642–64647 with modifier 50)
51 – Multiple procedures
59 – Distinct procedural services
Keep in mind that the supply of the chemodenervation agent is separately reportable. To report the product, use the appropriate Healthcare Common Procedure Coding System code. It is also important to document the units of the product that were used, the units that were discarded, and the national drug code number.
Update based on AAPM&R, AANEM, AAN, Allergan & Merz web based information. This information is only for review. The individual provider will need to determine what the proper billing procedure is for these codes in his or her locality for the specific payer to whom a claim is submitted. We cannot advise billing strategies or make allegations that any of these codes continue to be valid.
Please feel free to contact us should there be any comments about billing, to help us update this page.
Insurance – Guided Injection – OHIP Codes
OHIP Update: BOTULINUM TOXIN SERVICES (2015)
| Code | Description |
| G870 | Botulinum toxin injection(s) of extraocular muscle(s), (unilateral) |
| G871 | Botulinum toxin injection(s) for blepharospasm, (unilateral or bilateral) |
| G872 | Botulinum toxin injection(s) for hemifacial spasm, (unilateral or bilateral) |
| G873 | Botulinum toxin injection(s) for spasmodic dysphonia |
| G874 | Botulinum toxin injection(s) for sialorrhea, (unilateral or bilateral) |
| G875 | Botulinum toxin injection for the following conditions: Oromandibular dystonia, limb dystonia, cervical dystonia or spasticity - First injection |
| G876 | Botulinum toxin injection for the following conditions: Oromandibular dystonia, limb dystonia, cervical dystonia or spasticity - each additional injection to a maximum of 11, to G875 … add |
| G877 | EMG and/or ultrasound guidance for Botulinum toxin injections - with EMG guidance (when required to determine the injection site), for one injection, to G870, G873, G874, or G875 … add |
| G878 | EMG and/or ultrasound guidance for Botulinum toxin injections - with EMG guidance (when required to determine the injection site), for two or more injections, to G870, G873, G874 or G876 … add |
| E543 - EMG and/or ultrasound guidance for Botulinum toxin injections use of disposable EMG hypodermic electrode outside hospital (maximum of one per patient per day), to G877 or G878 … add | |
| G879 | EMG and/or ultrasound guidance for Botulinum toxin injections - with ultrasound guidance (when required to determine the injection site), for one injection, to G870, G873, G874 or G875 … add |
| G880 | EMG and/or ultrasound guidance for Botulinum toxin injections - with ultrasound guidance (when required to determine the injection site), for two or more injections, to G870, G873, G874 or G876 … add |
| G870 | Botulinum toxin injection(s) of extraocular muscle(s), (unilateral) |
| G871 | Botulinum toxin injection(s) for blepharospasm, (unilateral or bilateral) |
| G872 | Botulinum toxin injection(s) for hemifacial spasm, (unilateral or bilateral) |
| G873 | Botulinum toxin injection(s) for spasmodic dysphonia |
| G874 | Botulinum toxin injection(s) for sialorrhea, (unilateral or bilateral) |
Botulinum toxin injection for the following conditions: Oromandibular dystonia, limb dystonia, cervical dystonia or spasticity G875 First injection... G876 - each additional injection to a maximum of 11, to G875 - add
EMG and/or ultrasound guidance for Botulinum toxin injections G877- with EMG guidance (when required to determine the injection site), for one injection, to G870, G873, G874, or G875 ... add
G878- with EMG guidance (when required to determine the injection site), for two or more injections, to G870, G873, G874 or G876 ... add
E543- use of disposable EMG hypodermic electrode outside hospital (maximum of one per patient per day), to G877 or G878 ... add
G879- with ultrasound guidance (when required to determine the injection site), for one injection, to G870, G873, G874 or G875 ... add
G880- with ultrasound guidance (when required to determine the injection site), for two or more injections, to G870, G873, G874 or G876 ... add
Payment rules:
1. When used to determine the injection site, EMG or ultrasound services other than G877, G878, G879 or G880 are not eligible for payment with Botulinum toxin services.
- All Botulinum toxin services are limited to one treatment per condition, per patient every 10 weeks. If, in the opinion of the treating physician, more frequent treatments are necessary, submit claim for manual review with supporting documentation. Authorization will be dependent on the physician demonstrating that the increased frequency of the service is generally accepted as necessary for the patient under the circumstances.
[Commentary: Botulinum toxin injection(s) for indications other than those listed above are not insured services.]
OHIP: CHEMODENERVATION INJECTION Chemodenervation injection of individual peripheral motor nerve using phenol, ethyl alcohol or similar non-anaesthetic chemical agents for reduction of focal spasticity, and may include electromyography (EMG) guidance of injection(s).
G485 - first major nerve and/or branches ... G486 - each additional major nerve and/or its branches same day....add
Repeat or additional procedure within 30 days of previous chemodenervation injection
G487 - first major nerve and/or its branches... G488 - each additional major nerve and/or its branches same day ...add
- Use nerve block listings under Nerve Blocks subsection if anaesthetic agents are used instead of phenol or alcohol or similar non-anaesthetic chemical agents.
- Chemodenervation injection into same muscle same day as botulinum toxin is an insured service payable at nil.
Please feel free to contact us should there be any comments about OHIP billing, to help us update this page.