Neurology billing services from Medical Billing Services Group (MBSG) keep diagnostic and therapeutic claims clean — from office E&M and neurodiagnostic testing (EMG, nerve conduction studies, EEG) to chemodenervation and infusion therapies. We handle prior authorizations, bundling rules, and denials, so your practice captures the full value of every service.
Neurodiagnostic denials eating your margins? Get a Free Billing Audit — we will review your EMG, nerve conduction, and E&M claims and pinpoint exactly where revenue is leaking.
Practice/setting fit
Our neurology billing services fit general neurology practices, subspecialty programs (headache, movement disorders, epilepsy, neuromuscular), neurodiagnostic labs, and hospital-affiliated clinics. What makes neurology billing hard is the mix: high-volume office E&M layered with diagnostic testing that carries strict bundling rules, plus injectable and infusion therapies that each bring their own prior authorization and medical-necessity requirements.
We manage the full revenue cycle for these settings: benefits verification and prior authorization for scheduled testing and therapies, coding that respects procedure-to-procedure edits, daily claim submission, payment posting with contractual adjustments, and denial follow-up that goes back to the test report or procedure note. Our coding team reviews neurodiagnostic documentation against published edit rules before claims go out, and our broader specialty billing programs cover the rest of your service lines.
Documentation and coding risks
Neurology’s biggest billing risk is the boundary between the examination, the diagnostic test, and the therapy — each has its own edit rules. These are the rules we apply most often, each verified against a published CMS source.
Botulinum toxin in the hospital OPD needs prior authorization
Botulinum toxin injections sit on CMS’s hospital outpatient prior authorization list: when furnished in a hospital outpatient department, they require a prior authorization request with supporting documentation before the service, and a provisional affirmation is a condition of payment. This matters for neurology practices that administer chemodenervation (for example, for chronic migraine or dystonia) in a hospital-based clinic — the setting determines the rule, not the diagnosis. Office-based injections are not in the federal program, but commercial payers routinely require their own authorization for botulinum toxin. We confirm the setting and the payer’s requirement before every injection series is scheduled.
Payer/program: Medicare (CMS) · Jurisdiction: United States (federal) · Source: “Prior Authorization for Certain Hospital Outpatient Department (OPD) Services — botulinum toxin injections on the covered list (Noridian JF Part A; First Coast Service Options)” · Publication date: program effective July 1, 2020 for botulinum toxin · Effective date: July 1, 2020 · Last reviewed: 2026-10-08
EMG and nerve conduction studies trigger bundling edits
When electromyography and nerve conduction studies are performed in the same session, Medicare’s correct-coding edits pair certain code combinations as procedure-to-procedure edits — the components are not separately payable unless the documentation supports a distinct, separately identifiable service. The same principle applies to E&M reported on the same day as testing: the evaluation must stand apart from the work inherent in the diagnostic study. Practices that bill every component — or reflexively bundle everything — both lose revenue. We code from the complete test report and the office note, apply the current NCCI edit pairs, and use modifiers only where the documentation earns them.
Payer/program: Medicare (CMS) · Jurisdiction: United States (federal) · Source: “National Correct Coding Initiative Policy Manual for Practitioners, 2026 edition — verify the current chapter and edit pairs at cms.gov before relying on a specific combination” · Publication date: 2026 edition · Effective date: January 1, 2026 · Last reviewed: 2026-10-08
Repeat neurodiagnostic testing lives or dies on medical necessity
Medicare Administrative Contractors publish Local Coverage Determinations that define when repeat EMG, nerve conduction studies, EEGs, and chemodenervation are medically necessary — including frequency limits and the clinical changes that justify retesting. A repeat study ordered “to recheck” without documented clinical change is a denial waiting to happen, and the LCDs differ by jurisdiction. Our workflow checks the indication and the interval against the applicable LCD before the test is scheduled, so medical necessity is established in the record before the claim exists.
Payer/program: Medicare (CMS via MACs) · Jurisdiction: varies by MAC jurisdiction · Source: “Local Coverage Determinations for neurodiagnostic testing and chemodenervation, your Medicare Administrative Contractor (check the current LCD for your jurisdiction)” · Publication date: varies by LCD · Effective date: varies by LCD · Last reviewed: 2026-10-08
Not sure your neurodiagnostic coding would survive an audit? Get a Free Billing Audit — we will test a sample of claims against the rules above and show you the gaps.
Payer and authorization checks
Medicare’s neurology rules — including the prior authorization program and LCDs above — do not automatically apply to Medicaid or commercial plans. Commercial payers and Medicare Advantage plans run their own prior authorization portals with their own medical necessity criteria, and many require authorization for EMG/NCS, EEG, botulinum toxin, and infusion therapies even in the office setting. We verify authorization requirements before testing or therapy is scheduled, submit the clinical documentation each payer asks for — prior evaluations, failed therapies, functional impairment — and track the request to a written determination. We also track authorization expirations so a delayed case does not become an uncovered one.
Workflow and reporting
Neurology revenue lives in the test report and the office note, so our workflow starts with both. We reconcile scheduled testing and therapies against completed documentation, code from the full record (indications, studies performed, interpretation, therapy administered), scrub claims against payer-specific edit sets, submit daily, post payments, and work denials through our structured denial management process.
Reporting makes the pattern visible. Illustrative examples of what our reports show: a weekly denial snapshot grouped by root cause (prior authorization, medical necessity, bundling edits, coding), days in AR by payer, and a clean-claim rate trend for your testing and E&M lines. These are illustrative examples, not guarantees — results depend on payer mix, documentation quality, and case mix. But you will always see where revenue stands and what we are doing about it.
Onboarding and pricing factors
Onboarding starts with the free billing audit — a real review of recent claims, not a sales call. Implementation then covers payer enrollment verification, clearinghouse and EHR connections, neurodiagnostic charge-capture mapping, and a coding review of your highest-volume tests and therapies. Factors that shape a quote: monthly test and claim volume, office versus hospital-based mix, number of physicians and APPs, payer mix (including Medicare Advantage penetration), and whether you need full revenue cycle or billing only.
We do not publish one-size-fits-all rates because they would be meaningless at this complexity. Your proposal will specify the pricing model, minimum fees, and turnaround for implementation, along with the credentials of the team assigned to your account. We serve practices in all 50 states — call +1 (307) 396-4107 or email contact@medicalbillingservicesgroup.com, or review transparent pricing details.
FAQs and dated sources
Do you handle prior authorizations for Botox and other chemodenervation?
Yes. We confirm whether the injection setting triggers Medicare’s hospital OPD prior authorization or a commercial payer’s own requirement, prepare the request with supporting documentation, and track it to a written determination before the injection series is scheduled.
Why do our EMG and nerve conduction claims keep getting bundled?
Medicare’s procedure-to-procedure edits pair certain same-session diagnostic combinations. If the documentation does not support the components as distinct services, the edit stands. We code from the full test report and apply the current edit pairs before claims go out.
What drives most neurology denials?
The patterns we see most: missing or expired prior authorizations for testing and therapies, medical necessity documentation that does not meet the LCD’s criteria (especially repeat studies), and bundling-edit denials on same-day E&M and diagnostics. Our independent billing audit shows which pattern dominates your claims.
Do Medicare’s neurology rules apply to our commercial contracts?
Not automatically. Commercial payers and Medicare Advantage plans publish their own medical necessity criteria and authorization requirements. We check the rules for each payer on your panel instead of assuming Medicare’s policies govern everywhere.
How do we start working with MBSG?
Start with a free billing audit — we review recent claims across your office, testing, and therapy lines. Or contact our team directly to talk through your volume and payer mix.
Medical Billing Services Group — Medical Billing & Revenue Cycle Management. If neurology billing complexity is costing you procedures’ worth of revenue, start with a Free Billing Audit and see exactly where your claims stand.
General educational information, not legal advice or a guarantee of reimbursement. Requirements vary by payer, plan, setting and date of service.
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