95870 Insurance Policy Changes

CPT 95870, in plain terms, covers A needle test measuring electrical activity in muscles of one arm or leg to check for nerve or muscle problems. CPT 95870 is referenced in 4 tracked payer policy changes from Aetna, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 95870 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 95870 on AAPC

Aetna · Identified Aug 14, 2026Medium impact
Electrodiagnostic Testing (CPB 0502, reviewed 2026-07-29)
Aetna covers nerve conduction studies, needle EMG, neuromuscular junction testing, late responses (H-reflex and F-wave studies) and blink reflex studies when the listed criteria are met. Aetna considers two EDX tests per year medically necessary per diagnosis, and considers one additional test per year for listed conditions when medical records document the need. Aetna considers nerve conduction studies experimental, investigational, or unproven for screening neuropathy when symptoms and physical findings are mild, primarily sensory and have a known cause.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Intraoperative Neurophysiologic Monitoring
Intraoperative neurophysiologic monitoring, including somatosensory-evoked potentials, motor-evoked potentials using transcranial electrical stimulation, brainstem auditory-evoked potentials, cranial nerve EMG, EEG, and ECoG, may be considered medically necessary during spinal, intracranial, and vascular procedures. Monitoring of the recurrent laryngeal nerve may be considered medically necessary during high-risk thyroid or parathyroid surgery and during anterior cervical spine surgery with listed increased-risk situations. Recurrent laryngeal nerve monitoring during other anterior cervical spine surgery or during esophageal surgery is investigational. Visual-evoked potential monitoring, motor-evoked potential monitoring using transcranial magnetic stimulation, and intraoperative EMG and nerve conduction velocity monitoring during peripheral nerve surgery are considered investigational. The policy was reviewed 09/16/2026, when the first policy statement was updated to list the procedures.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Electromyography (EMG)
Invasive (needle) EMG is outside a chiropractor's scope of practice under the Mississippi law cited in the policy, so it can only be performed by physicians, primarily neurologists. Non-invasive surface EMG has not been scientifically demonstrated as a useful tool for evaluating radiculopathy, and some surface EMGs are not medically necessary and are investigational in nature. EMG is covered for diagnostic purposes in spinal cord injury, herniated nucleus pulposus, thoracic outlet syndrome, nerve syndrome, back and extremity pain, peripheral neuritis and the Tensilon test for myasthenia gravis, and for treatment of pathological muscle abnormalities for spasticity, incapacitating muscle spasm and semiparesis.
Blue Cross of Idaho · Identified Jun 19, 2026Medium impact
PAP516 - Intraoperative Monitoring - Typo error fixed from 95860-85870, to 95860-95870
Blue Cross of Idaho corrected a typo in PAP516 that previously listed an invalid CPT code range (95860-85870). The policy now correctly references CPT codes 95860-95870 as primary codes that can be billed with Intraoperative Neurophysiologic Monitoring (IONM) services. This correction ensures billing teams use the accurate code range for IONM claim submission.

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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 95870?

CalViva Health lists 95870 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 95870?

Community Health Plan of Imperial Valley lists 95870 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 95870?

There are 4 tracked policy changes affecting CPT 95870, including updates from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross of Idaho. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 95870?

Payers that have issued tracked updates for CPT 95870 include: Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross of Idaho.

How do I get notified when CPT 95870 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 95870. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 95870?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 95870 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Electrodiagnostic Testing (CPB 0502, reviewed 2026-07-29)

Intraoperative Neurophysiologic Monitoring

Electromyography (EMG)

PAP516 - Intraoperative Monitoring - Typo error fixed from 95860-85870, to 95860-95870

Prior authorization required