Coding, prior authorization, front-desk support, patient growth and a claims portal for neurology practices, built on your Medicare contractor's articles and your payers' own policies.
Quick answer
Neurology billing services code, submit and follow up on claims for office visits, nerve conduction studies and EMG, EEG monitoring, sleep testing, Botox injections and infused drugs. Each follows its own Medicare contractor rules on study counts, recording hours, headache diaries and prior authorization. RCM Finder pairs that billing with front-desk staff, patient marketing and a claims portal.
Neurology billing is different because one practice runs three kinds of revenue at once: office visits, diagnostic testing and drug-based procedures. Each has its own Medicare contractor rules, counting logic and prior authorization path.
Diagnostic testing shows how specific this gets. Under the Wisconsin Physicians Service (WPS) nerve conduction and EMG LCD (L34594), which covers Indiana and Michigan, a nerve conduction study without needle EMG is usually not medically necessary, outside narrow carpal tunnel testing. Routine polyneuropathy testing in diabetes or end-stage renal disease is not covered. Its billing article A57478 lists a reasonable maximum number of studies for each diagnosis. Other contractors publish their own versions, such as CGS L35897 for Kentucky and Ohio.
CMS has also approved Recovery Audit reviews of hospital outpatient claims for nerve conduction studies billed with excessive units and for polysomnography medical necessity.
We build our billing pipeline around how claims actually move through a practice: registration, charge entry, submission, payment and follow-up. For the pain side of a combined group, see our pain management billing services page; for day-to-day problems, read common neurology billing challenges.
A neurology practice needs referrals coming in, tests and drugs cleared before the visit, claims coded to the contractor's rules, and software that shows where each claim sits.
Revenue leaks at the handoffs, such as a Botox visit booked before the diary is complete. We run all four pillars against one set of payer rules.
Our healthcare digital marketing builds demand from referring offices and local patients seeking headache, neuropathy, epilepsy, sleep or memory care. HHS guidance on online tracking says tracking on appointment pages can collect patient data, so we keep it off those pages unless the vendor signs a BAA.
Our virtual medical assistants work your front desk on your practice's time zone. They verify eligibility, gather outside records, send headache diaries and sleep questionnaires, and start prior authorizations for Botox, infusions and sleep studies.
Our end-to-end revenue cycle management covers coding support, claim scrubbing, denial management and A/R follow-up, with added checks on study counts, EEG hours, drug units and wastage, and same-day visits.
Our practice management system portal tracks every claim by stage, applies specialty-aware billing logic per claim, checks completeness before submission and flags underpayments.
Find where your neurology claims stall
We review recent test, Botox and infusion claims and denial reasons, then show what to fix first. Pricing is quoted after the audit.
Most neurology denials trace to a few causes: too many studies for the diagnosis, the wrong code family for the day, EEG time or monitoring the record does not support, and drug claims missing criteria, units or a wastage modifier.
Codes are examples in our own words (the AMA owns CPT descriptors). Indiana examples use WPS documents; other MACs may differ.
| Service | Code examples (our wording) | What the payer asks to see | Common error or denial trigger |
|---|---|---|---|
| NCS with same-day needle EMG | 95907–95913 (NCS, by total studies: 1–2 up to 13+); 95885, 95886, 95887 (EMG with NCS: limited limb, complete limb, non-limb) | Clinical history from the referring provider; NCS numbers (amplitude, latency, velocity); a diagnostic impression | Over the diagnosis maximum without added notes; NCS alone outside carpal tunnel testing; routine diabetic or ESRD neuropathy testing |
| Needle EMG without NCS | 95860–95864, 95867–95870 | Muscles tested and findings for each | Standalone codes billed with a same-day NCS; repeat EMG at one site to guide Botox |
| Routine EEG | 95816 (awake and drowsy); 95819 (awake and asleep) | Which states were recorded (the code depends on it) | Billed with long-term EEG codes, or with polysomnography without a separate complete EEG |
| Long-term and video EEG | 95700 (setup); 95705–95716 (technical, by hours, video and monitoring level); 95717–95726 (professional read) | Total hours, video use and monitoring level | Continuous monitoring billed for more than 4 concurrent patients; daily and whole-study reads billed together |
| Botox for chronic migraine | 64615 (both sides, head and neck muscles); J0585 (onabotulinumtoxinA, per unit) | 15+ headache and 8+ migraine days a month; two preventive drug classes tried; baseline on a set scale | Repeat within 12 weeks or without 50% improvement; OPD claim without a tracking number; no JW or JZ |
| Sleep testing | 95810 (in-lab study); 95811 (in-lab with PAP titration); G0398–G0400 (home tests, types II–IV) | Treating practitioner's order; credentialed staff and facility; a comprehensive sleep evaluation with any home test | Home test outside OSA or with listed comorbidities; insomnia-only studies; over 2 nights without justification |
Sources: CMS Medicare Coverage Database (WPS L34594, A57478, L36839 and L39909; Wellpoint L39832 and Noridian L35170, 2026; NCD 240.4.1); CMS OPD and JW/JZ FAQs; NCCI manual ch. 11 (2026); NAEC (2019); AASM (2024); AAPC and VUMC. Rules vary by MAC and payer.
Under WPS A57478, sensory, motor and H-reflex testing on one nerve are separate studies, each counted once however many sites are stimulated. Standalone needle EMG codes apply only when no nerve study is done that day; with one, use 95885, 95886 or 95887. A separate office visit on the test day needs its own documentation and modifier 25 (see our modifier 25 vs 59 explainer). Testing beyond a diagnosis maximum, or testing an opposite limb without symptoms, needs added documentation.
The National Association of Epilepsy Centers' guide to the 2020 code changes says routine EEG codes are not reported with the long-term set, which splits setup, technical monitoring and the professional read. Continuous real-time monitoring allows up to 4 patients at once; intermittent monitoring needs a documented review every 2 hours, with up to 12 patients.
NCD 240.4.1 covers in-lab and several home test types for suspected obstructive sleep apnea when a treating practitioner orders them. WPS L36839 adds credentials for physicians, technologists and facilities, covers home testing only for likely moderate to severe OSA and only with a comprehensive sleep evaluation, and excludes chronic insomnia. The 2026 NCCI policy manual bars billing a sleep study and polysomnography for the same encounter. For diagnosis coding, see our guides to headache ICD-10 codes and obstructive sleep apnea ICD-10 coding.
Start prior authorization at scheduling, and check the site of service first. For Original Medicare, Botox needs prior authorization only in a hospital outpatient department. Medicare Advantage and commercial plans keep their own lists.
CMS added botulinum toxin injections to its hospital outpatient prior authorization program on July 1, 2020. The CMS OPD FAQ says it applies only when J0585, J0586, J0587 or J0588 is billed with 64612 or 64615 in a hospital outpatient department, not an office or ASC. Physicians may submit for the hospital. If a request is not affirmed, related physician services are denied, and each tracking number covers one claim.
New botulinum toxin LCDs took effect February 22, 2026, including WPS L39909 for Indiana and Michigan, Wellpoint L39832 and Noridian L35170. A first injection needs 15 or more headache days a month, 8 or more migraine days lasting 4 hours or more, symptoms for at least 3 months, and 2-month trials from two preventive drug classes (or a contraindication). Repeats need at least 50% fewer monthly migraine days and episodes, plus less disability, and no dose within 12 weeks of the last. In April 2026, several MACs released new draft LCDs, WPS among them, so check your contractor's current version.
CMS's JW and JZ modifier policy requires JW for the discarded amount of a single-dose container drug and JZ when nothing was discarded; claims without them may be returned as unprocessable. Since 2019, Medicare Advantage plans may apply step therapy to Part B drugs for new starts. Medicare covers anti-amyloid antibodies for Alzheimer's disease only under coverage with evidence development, with registry data due at the first treatment and every six months for up to 24 months. See our guide to infusion and IVIG billing.
Since January 1, 2026, CMS-0057-F has required Medicare Advantage, Medicaid and CHIP plans to decide expedited requests within 72 hours and standard ones within 7 calendar days, with a specific reason for any denial; drug requests are excluded. In KFF's January 2026 analysis, Medicare Advantage insurers denied 7.7% of 52.8 million prior authorization determinations in 2024; just 11.5% of denials were appealed, and 80.7% of appeals were overturned in part or in full. Our prior authorization guide covers the general process.
| Payer rule | Source | What the front desk or VMA checks |
|---|---|---|
| Hospital OPD Botox (J0585–J0588 with 64612 or 64615) needs Medicare prior authorization; offices and ASCs excluded | CMS OPD program and FAQ | Site of service; for OPD cases, a tracking number for that claim |
| First chronic migraine injection: 15+ headache days, 8+ migraine days, 4+ hours, 3+ months; two drug classes tried | WPS L39909; Wellpoint L39832; Noridian L35170 | Headache diary and drug trial history charted before booking |
| Repeat injection: 50%+ fewer migraine days and episodes; 12 weeks since the last | WPS L39909; Wellpoint L39832; Noridian L35170 | Last injection date; response on the baseline scale |
| Medicare Advantage may require step therapy for Part B drugs (new starts only) | CMS fact sheet (2018); 42 CFR 422.136 | Plan's preferred-drug step; exception request if needed |
| Anti-amyloid antibodies: covered only under CED; data at first treatment, then every 6 months | CMS CED page; NCD 200.3 | Registry enrollment confirmed; follow-up dates calendared |
| Home sleep test: likely moderate to severe OSA, done with a comprehensive sleep evaluation | WPS L36839 | Evaluation note, order and comorbidity screen before the device ships |
Sources: CMS OPD program page (2026) and FAQ (2024); WPS L39909, Wellpoint L39832 and Noridian L35170 (2026); WPS L36839 (2025); CMS step therapy fact sheet (2018) and 42 CFR 422.136; CMS CED page and NCD 200.3. Your MAC may differ.
Estimate what denied tests and injections cost you
Model how denials and slow A/R affect a testing-heavy neurology practice, then bring the numbers to your audit.
Medicare's telehealth flexibilities now run through December 31, 2027, according to CMS's telehealth FAQ updated February 26, 2026. Until then, beneficiaries can receive telehealth anywhere in the United States, including at home. From January 1, 2028, most non-behavioral telehealth again requires the patient to be in a medical facility in a rural area.
CMS says the extension applies retroactively to the lapse that began October 1, 2025. Bill POS 10 when the patient is at home and POS 02 when the patient is elsewhere; home telehealth has been paid at the non-facility rate since January 1, 2024. Under current law, audio-only visits to the home continue through the same date. Acute stroke care outlasts the flexibilities: 42 CFR 410.78 has exempted it from geographic limits since January 1, 2019, with no end date, and CMS's telehealth booklet (December 2025) says geographic limits do not apply to diagnosing and treating acute stroke and lists mobile stroke units as originating sites. See our telehealth billing guide.
Choose based on where claims break. If denials start with missing diaries or unapproved injections, a billing-only vendor sees them too late. If your front desk and documentation are strong, outsourced billing alone may be enough.
| Question | In-house team | Billing-only vendor | Four-pillar partner |
|---|---|---|---|
| Who collects headache diaries before Botox? | Clinical staff, between visits | Usually left to the practice | Virtual medical assistants, using billing's checklist |
| Who handles hospital OPD Botox and plan infusion authorizations? | Your staff or the hospital's | Depends on the contract | VMA team requests and logs each decision |
| Who checks NCS counts, EMG code family and EEG hours? | Your coder, if neurology-experienced | Vendor coders and scrubber | RCM team plus portal completeness checks |
| Who connects referrals to paid claims? | Rarely anyone | Not in scope | Shared KPIs from referral to paid claim |
| Strongest fit when | Staff are trained and turnover is low | Front end is strong; you need claims work only | Gaps span scheduling, prior auth, billing and growth |
If you need only one pillar, the audit will say so. Our revenue cycle management services and virtual medical assistant services can be contracted separately.
We start with a free audit, put a Business Associate Agreement in place, then take over the parts you choose inside your existing EHR.
We review recent EMG, EEG, sleep, Botox and infusion claims, denial reasons and how they are booked. You get a prioritized fix list.
We put a Business Associate Agreement in place before accessing patient data, then set role-based access in your EHR (for example PrognoCIS, eClinicalWorks or athenahealth) and our portal.
We map your MAC's articles and main plans: study limits, EEG rules, Botox criteria and authorization lists.
Virtual medical assistants start pre-visit checks on your time zone. The RCM team codes, scrubs, submits and works denials and A/R.
You see denial reasons, authorization turnaround, A/R days and underpayments each week, and we adjust rules where claims stall.
Talk through your neurology workflow
Call to walk through your test mix, your MAC and where claims stall. We will tell you which pillars you need.
Any vendor that handles your claims is a HIPAA business associate and must sign a Business Associate Agreement before seeing patient data. Also ask how it limits access, logs activity and tracks LCD changes.
HHS guidance lists billing, claims processing and practice management as business associate work, and subcontractors need their own agreement. The minimum necessary standard limits each use to what the task needs. The Security Rule's technical safeguards cover access control, audit controls, integrity, person or entity authentication and transmission security. For your own side, use our HIPAA compliance checklist for medical practices.
For RCM Finder: role-based access, an audit log, encrypted (HTTPS) connections, and we put a Business Associate Agreement in place before accessing patient data.
We would rather tell you now than after you sign. Here is where we fit and where we do not.
A good fit if you are
Probably not a fit if you are
What we would do first if we were running your practice's revenue cycle tomorrow.
Pull your MAC's billing article and its maximum-studies table. We set study-count checks from that document.
Botox coverage rests on headache days, migraine days and response on one scale. We collect diaries before injection visits.
Hospital OPD injections need a Medicare tracking number; office injections do not under that program. We check the site, then the plan.
Document the dose given and amount discarded, then bill JW or JZ. We check each single-dose drug line.
Bill the monitoring level your technologist coverage supports, and log hours and video use. We flag claims where record and code disagree.
Under WPS rules, a home sleep test is covered only with a comprehensive sleep evaluation and for likely moderate to severe OSA without listed comorbidities. We screen before the device ships.
They cover coding support, claim scrubbing, submission, denial management and A/R follow-up for neurology visits and tests: nerve conduction studies and EMG, routine and long-term EEG, sleep testing, Botox injections and infused drugs. A good service also checks eligibility and payer criteria before the visit. RCM Finder adds front-desk staff, patient marketing and a claims portal, so the same rules apply from referral to payment.
Choose the nerve conduction code by the total number of studies, from 95907 for one or two up to 95913 for 13 or more. Each study type on each nerve counts once. When needle EMG is done the same day, use 95885, 95886 or 95887 instead of the standalone EMG codes. WPS also lists a reasonable maximum number of studies per diagnosis, and going over it needs added documentation.
Only in one setting under the national program. Since July 1, 2020, CMS has required prior authorization for botulinum toxin injections in hospital outpatient departments when the drug is billed with 64612 or 64615. Offices and ASCs are outside that program. Coverage still depends on your MAC's LCD, such as 15 or more headache days a month and documented preventive drug trials. Medicare Advantage plans set their own rules.
Yes, through December 31, 2027. CMS's February 2026 FAQ says beneficiaries can receive telehealth anywhere in the United States until then. Use POS 10 when the patient is at home and POS 02 elsewhere. From January 1, 2028, most non-behavioral telehealth again requires a medical facility in a rural area, although acute stroke care is exempt from geographic limits.
Common triggers in Medicare articles include nerve studies above the diagnosis maximum without added notes, standalone EMG codes billed with a same-day nerve study, EEG codes that do not match recording time or monitoring, Botox without diary data or given sooner than 12 weeks, missing JW or JZ modifiers, and home sleep tests outside covered indications. Most can be caught before the visit or before the claim goes out.
Outsource when denials, authorizations or A/R outrun your staff. Look for neurology coding experience, a signed BAA, MAC-specific rule tracking and reporting by denial reason. Our team works inside your existing EHR, for example PrognoCIS, eClinicalWorks or athenahealth, and we put a Business Associate Agreement in place before accessing patient data. Pricing depends on your test mix, claim volume and pillars, so we quote it after a free audit.
Tell us about your practice. A member of our operations team replies within one business day.
Pricing is quoted after the audit, based on your volume and the services you choose. Prefer to talk? Call +1 (302) 556-2288.
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