Neurology Medical Billing Experts
Maximize your neurology practice revenue with specialized billing for EMG/NCS, EEG, Botox injections, and complex neurological care. Expert electrodiagnostic coding, infusion therapy billing, and comprehensive revenue optimization.
Neurology Services
- EMG & Nerve Conduction Studies
- EEG & Brain Monitoring
- Botox & Neurotoxin Injections
- Infusion Therapy Billing
- Complex E/M Optimization
- Diagnostic Test Coordination
Industry-Leading Neurology Billing Performance
Our specialized neurology billing consistently outperforms benchmarks
Neurology Billing Challenges We Solve
Complex electrodiagnostic and therapeutic procedures require specialized expertise
EMG and NCS Coding Complexity
Electromyography and nerve conduction studies involve multiple components requiring separate coding. Limited studies vs complete studies, number of muscles/nerves tested, and bilateral procedures all affect reimbursement. Incorrect code selection reduces payment by 30-50%.
Average neurology practice loses $65,000 annually on EMG/NCS coding errors
EEG Technical and Professional Components
Electroencephalograms require separation of technical (equipment, technician) and professional (interpretation) components. Routine EEG vs prolonged monitoring, ambulatory EEG, and video EEG have different billing requirements and global periods.
Component billing errors cost practices $40K+ annually
Botox and Neurotoxin Injection Billing
Botox injections for chronic migraine, cervical dystonia, and spasticity require specific diagnosis codes, unit-based billing (not per-vial), and proper J-code documentation. Medicare has strict coverage criteria requiring detailed medical necessity documentation.
Botox billing denials average $3,000-5,000 per case without proper coding
Complex E/M Coding for Neurological Conditions
Neurological evaluations involve extensive history taking, detailed neurological exams, and complex medical decision-making. Proper documentation of all exam elements (mental status, cranial nerves, motor, sensory, reflexes) is essential for appropriate E/M level assignment.
Undercoding costs average neurologist $55,000 annually
Multiple Diagnostic Test Coordination
Neurology patients often require multiple diagnostic studies - MRI, CT, PET scans, lumbar puncture, sleep studies. Coordinating billing between neurology, radiology, and pathology while avoiding duplicate billing requires systematic workflows.
Coordination errors cause $25K-40K annual revenue loss
Infusion Therapy and Chemotherapy Administration
Neurologists administering IV infusions for MS, myasthenia gravis, or migraine need proper infusion codes, drug codes (J-codes), and time-based billing. Concurrent infusions, push vs drip, and add-on codes require precise documentation.
Infusion billing errors reduce revenue 20-35% per infusion session
Comprehensive Neurology Service Coverage
Expert billing across all neurology services and procedures
Electrodiagnostic Testing
EMG, nerve conduction studies, and specialized neurophysiologic testing.
EMG (4+ extremities)
$450-680CPT 95860-95864
Needle electrode examination
Nerve Conduction Studies
$380-550CPT 95907-95913
Motor and sensory NCS
Single Fiber EMG
$320CPT 95872
Myasthenia gravis evaluation
H-Reflex Study
$180-240CPT 95934-95936
Reflex latency testing
Billing Note: Document number of muscles/nerves tested, laterality, and medical necessity for study extent.
EEG and Brain Monitoring
Electroencephalography for seizure evaluation and brain function monitoring.
Routine EEG (20-40 min)
$280CPT 95816
Standard EEG with recording
Prolonged EEG (over 1 hour)
$520CPT 95827
Extended monitoring
Ambulatory 24-hour EEG
$850CPT 95950-95953
Portable long-term monitoring
Video EEG Monitoring
$1,200/dayCPT 95951
Inpatient epilepsy monitoring
Billing Note: Separate technical and professional components; track monitoring duration precisely.
Therapeutic Injections
Botox, neurotoxin injections, and nerve blocks for neurological conditions.
Botox for Chronic Migraine
$1,400-1,800CPT 64615 + J0585
Multiple injection sites
Cervical Dystonia Injection
$1,200-1,600CPT 64616 + J0585
Neck muscle injections
Spasticity Management
$800-1,400CPT 64642-64647
Limb spasticity treatment
Occipital Nerve Block
$240CPT 64405
Headache treatment
Billing Note: Bill by units administered, not vials; ensure diagnosis codes support medical necessity.
Office Neurology Services
Neurological consultations, evaluations, and follow-up care.
Complex Neurology Consultation
$280-420CPT 99204-99205
New patient comprehensive eval
Established Patient Visit
$180-280CPT 99213-99215
Follow-up neurological care
Prolonged Service Add-on
$110-150CPT 99354-99355
Extended visit time
Care Plan Oversight
$90-150CPT 99339-99340
Monthly care coordination
Billing Note: Document complete neurological exam elements and time when applicable.
Infusion Therapy
IV infusions for MS, migraine, and neuromuscular conditions.
Initial IV Infusion
$280CPT 96365
First hour therapeutic infusion
Additional Infusion Hour
$95/hrCPT 96366
Each additional hour
IV Push Administration
$120CPT 96374
Single drug push
Concurrent Infusion
$110CPT 96368
Second drug simultaneously
Billing Note: Track start/stop times precisely; use appropriate J-codes for medications administered.
Neurology Practice Success Stories
Real results from neurology practices we've transformed
Multi-Specialty Neurology Group Optimization
8 neurologists with in-office EMG/EEG labChallenge
Practice losing $85K annually on EMG/NCS coding errors, EEG component billing inconsistencies, and Botox denials averaging 22%.
Solution
Implemented electrodiagnostic coding specialists, created component billing workflows, developed Botox medical necessity documentation templates.
Results
- ✓EMG/NCS coding accuracy improved from 79% to 97%
- ✓EEG professional/technical separation: 100% compliant
- ✓Botox approval rate increased to 96%
- ✓Annual revenue increase of $195,000
Academic Neurology Department Revenue Recovery
12-neurologist academic practice with fellowsChallenge
E/M undercoding costing $180K annually, prolonged service codes never billed despite complex cases, infusion therapy billing incomplete.
Solution
Trained attending physicians on 2021 E/M guidelines, implemented time-tracking for prolonged services, created infusion billing checklists with J-code coordination.
Results
- ✓E/M level distribution optimized - 45% increase in level 4-5
- ✓Captured 120 prolonged service codes monthly
- ✓Infusion therapy revenue increased 280%
- ✓Department revenue increased $312,000
Headache and Botox Specialty Practice
Neurology practice specializing in headache treatmentChallenge
Chronic migraine Botox denials at 28%, injection coding inconsistent, missing documentation for medical necessity causing audit takebacks.
Solution
Implemented Botox-specific documentation system, trained staff on unit-based billing, created medical necessity checklists, established prior authorization protocols.
Results
- ✓Botox denial rate reduced from 28% to 3.2%
- ✓Average Botox reimbursement increased to $1,720
- ✓Audit findings resolved completely
- ✓Practice revenue increased $145,000 annually
Neurology Billing Questions Answered
Expert answers to your neurology billing questions
How do you handle the complex coding for EMG and nerve conduction studies?
EMG/NCS coding requires detailed documentation of muscles and nerves tested. We track whether studies are limited (1-2 extremities) vs complete (4+ extremities), count specific muscles for needle EMG (95860-95864 scale by number), and separately code nerve conduction studies (95907-95913 based on number of tests). We ensure modifiers are properly applied - modifier 26 for physician interpretation, TC for facility technical component. Our electrodiagnostic coding specialists achieve 97% accuracy compared to industry average of 82%, capturing full reimbursement for complex studies that often involve 15-20 separate nerve/muscle tests.
What is your approach to Botox and neurotoxin injection billing?
Botox billing requires unit-based coding (not per-vial) using appropriate injection codes (64612-64647) plus drug code J0585. For chronic migraine, we use 64615 for multiple injection sites, documenting all 31 injection points per protocol. Diagnosis codes must support medical necessity - failed preventive treatments, headache frequency, and disability documentation. We track units administered precisely (typically 155-200 units for migraine). Prior authorization is obtained before treatment. Our systematic approach has reduced Botox denial rates from industry average 25% to under 4%, while increasing average reimbursement from $1,200 to $1,650 per treatment.
How do you optimize E/M coding for complex neurological evaluations?
Neurological E/M optimization requires documentation of all exam components: detailed history of present illness, comprehensive review of systems (often 10+ for neuro patients), complete neurological exam (mental status, cranial nerves, motor/sensory/reflex testing, coordination, gait), and complex medical decision-making. We implement templates prompting for all required elements. For new patient consultations, we ensure comprehensive history and exam support level 4-5 codes (99204-99205). Time-based coding is used when >50% visit is counseling/coordination. Our approach has increased average E/M level from 1.8 to 2.3, adding $55,000 annually per neurologist.
Can you handle both professional and technical component billing for diagnostic tests?
Yes, we specialize in component separation for neurology diagnostics. For in-office EEG/EMG, we bill technical component (equipment, technician time, supplies) and professional component (physician interpretation) separately or globally depending on practice setting. Hospital-based neurologists bill professional component only (modifier 26). We track which components your practice can bill based on equipment ownership, staffing, and location. For sleep studies, ambulatory EEG, and video monitoring, we ensure all billable components are captured. This precision increases diagnostic test revenue by average 30%.
How do you handle infusion therapy billing for MS and other neurological conditions?
Infusion therapy requires precise time tracking and proper code sequencing. Initial infusion (96365) covers first hour, add-on codes (96366) for each additional hour. We track start/stop times to the minute. Drug J-codes must match what's administered - different J-codes for Tysabri, Ocrevus, Lemtrada, etc. For concurrent infusions (pre-meds plus therapeutic drug), we use hierarchy rules - primary therapeutic drug first, then concurrent code (96368). Diagnosis codes must support medical necessity. Our infusion billing specialists coordinate with pharmacy to ensure J-code accuracy and have increased infusion revenue by 280% for practices previously billing incompletely.
What about billing for prolonged services and complex care coordination?
Neurologists frequently spend extended time with complex patients but rarely capture prolonged service codes. We implement time-tracking protocols - when face-to-face time exceeds base code time by 30+ minutes, we bill add-on codes 99354-99355 (office) or 99356-99357 (hospital). Each code adds $110-150. For patients requiring ongoing care coordination (Parkinson's, ALS, dementia), we track monthly care plan oversight (99339-99340) which pays $90-150 monthly for 15-29 minutes of non-face-to-face coordination. These codes add 8-12 claims monthly per neurologist, generating $12,000-18,000 additional annual revenue.
How do you stay current with neurology coding and coverage policies?
Our neurology billing team includes certified coders with specific neurology training. We monitor CPT changes affecting neurophysiologic testing, track Medicare LCD (Local Coverage Determination) updates for EMG/NCS medical necessity, and follow payer policy changes for Botox coverage. Recent important updates include expanded Botox indications for chronic migraine, new codes for specialized EEG monitoring, revised E/M guidelines impacting neurology visits, and changing coverage for disease-modifying MS therapies. We attend neurology coding conferences, participate in American Academy of Neurology billing forums, and maintain relationships with neurology coding experts.
What metrics should neurology practices track for revenue optimization?
Key neurology metrics include: EMG/NCS utilization rate, average EMG reimbursement (target: $550+), EEG volume and component accuracy, Botox approval rate (target: 95%+), E/M level distribution (target: 40%+ level 4-5), clean claim rate (target: 95%+), denial rate (target: <4%), days in AR (target: <35 days), and infusion therapy per-hour revenue. We provide monthly scorecards with physician-specific benchmarking. Common findings: some neurologists consistently undercode E/M visits, others don't capture prolonged services despite spending extra time, and many miss billable care coordination. Data-driven feedback enables targeted improvement.
Optimize Your Neurology Practice Revenue
Join hundreds of neurologists who have increased revenue by 27% with our specialized billing services. Get a free practice analysis today.
✓ EMG/EEG specialists ✓ Botox coding experts ✓ Infusion therapy billing