Neurology Billing Guidelines: What’s New and What’s Required
Neurology billing guidelines have recently been updated to include major changes in CPT codes, telehealth billing, and documentation standards. These updates were made to bring more clarity, accuracy, and transparency to how neurological services are billed, coded, and reimbursed. Without adopting these updates, practices may face claim denials, delayed payments, and compliance failures.
Payers such as Medicare and UnitedHealthcare have increased their audits and claim scrutiny—especially around modifier use and time‑based billing codes. It has become more important than ever for neurology practices to stay current to ensure clean claims and maximum reimbursement.
1. Why Neurostimulator Claims Are Being Flagged
Neurostimulator claims are now being closely reviewed when documentation is incomplete.
Both the device programming and full clinical evaluation must be clearly noted.
When only part of the story is told, claims are rejected or delayed.
Billing teams are now being instructed to document both components fully.
“Missing half the story in neurology billing is like diagnosing a headache with a horoscope.”
2. Common Telehealth Billing Mistakes
Telehealth claims for neurology have frequently been denied due to missing consent or incorrect modifier use.
Audio and video services must be clearly separated using modifier 93 or 95, and documentation must include patient consent and platform details.
Even small omissions—such as skipping a modifier or platform mention—have resulted in claim rejections or audits.
Suggested resource: review examples in our Neurology Billing Challenges case study to see real corrections in action.3. Why Unspecified Diagnosis Codes Are Getting Rejected
3. Why Unspecified Diagnosis Codes Are Getting Rejected
Claims using unspecified ICD‑10 codes are being rejected more often.
Specific diagnosis codes must now be used to show medical necessity.
Codes like G40.909 are being flagged when more accurate options are available.
Careful review of documentation before coding has helped to reduce these denials—our Medical Coding Audit Services helped many practices prevent recurring errors.
4. Why Insurance Companies Are Setting Their Own Rules
Payers now maintain their own billing standards that may differ from Medicare.
Items that work for Medicare may not work for Aetna or other commercial payers.
Customized claim submissions are being encouraged to reduce delays.
Billing teams are now tracking monthly payer policy bulletins.
5. Neurology Audits Have Increased — Here's What They're Looking For
Audits are now focused on services such as EEGs, nerve studies, and level 5 visits.
Repeated use of high codes or modifiers without documentation support is being reviewed.
Medical necessity and time‑based documentation are being checked closely.
Internal audits are recommended to stay prepared and avoid “takebacks.”
What’s Required in Neurology Billing Guidelines
1. How Better Neurology Notes Can Stop Denials
Copied or incomplete clinical notes have become a major reason for claim rejections.
Patient history, exam findings, and medical necessity must be clearly written.
Generic templates have triggered audits and payment delays.
Customized physician‑driven templates are now being used to improve billing success.
“In billing, shortcuts are just long‑cuts to denial hell.”
2. Exact Time Logging for Time‑Based Services
Prolonged or care coordination visits must include exact minutes in the chart.
Even detailed reports have been denied if time information was missing.
Billing teams are now advised to document both start and end times clearly.
3. Avoiding “Unspecified” ICD‑10 Codes
Default unspecified ICD‑10 codes are resulting in underpayments.
Coders are now being trained to select more accurate, specific codes.
Matching the diagnosis closely with treatment has led to higher approval rates.
4. Choosing the Right E/M Level
Higher-level codes are under increased scrutiny due to improper justification.
Payers now require either total time or medical decision-making (MDM)—but not both.
Updated MDM guidelines are being used to reduce compliance risk.
“Accuracy in neurology billing isn’t just about numbers—it’s about telling the patient’s story the right way.”
5. Following Each Payer’s Rules
Billing rules now differ significantly between Medicare, Aetna, and commercial insurers.
Separate logs are being maintained for modifiers, time rules, and documentation requirements.
Customized submissions per insurer are leading to better claim success.
Neurology Billing: Then vs. Now
| Billing Element | Old Practice | What’s Required Now |
|---|---|---|
| Documentation Style | Generic, template-based | Custom notes with history, exam, MDM, necessity |
| Time‑Based Codes | Estimated or omitted time | Exact minutes documented |
| ICD‑10 Code Selection | Broad/unspecified codes | Precise, condition-specific codes |
| Modifier Usage (25,93,95) | Added without context | Backed by documentation and correct place-of-service |
| Payer Policy Knowledge | Generic billing strategy | Customized claims per insurer |
| E/M Code Justification | Based on provider habits | Must match complexity or time with accurate MDM |
| Telehealth Visit Billing | Basic codes without details | Consent, platform, and mode documented |
Real-World Billing Challenges & Solutions
| Challenge | How It Was Solved |
|---|---|
| Incomplete office visit documentation | Custom, physician‑driven templates were adopted |
| Denials due to missing modifiers | Modifier use was mapped per CPT and payer rules |
| Telehealth claims rejected | Encounter notes were updated with mode, platform, and consent |
| Use of unspecified ICD‑10 codes | Neurology-specific coder training was implemented |
| E/M upcoding and audit risks | Updated MDM tables were used for accurate coding |
Conclusion
Neurology billing in 2025 requires strong focus on compliance, documentation, and payer-specific rules. As CPT codes evolve and audits increase, errors in coding or documentation can result in significant denied claims. By updating old practices and aligning with modern rules, clean claim rates may increase by over 20 in six months, according to internal data at Medical Billing Wholesalers.
Frequently Asked Questions (FAQs)
HCPCS codes are used to bill non-physician services, medical supplies, drugs, and ambulance services to Medicare and Medicaid.
CPT codes represent physician services. HCPCS codes, especially Level II, cover products and services CPT doesn’t list.
Common examples include A4550 (surgical tray), J1050 (injectable drug), and E0110 (crutches).
Not necessarily. While Medicare and Medicaid require them, commercial payers may use CPT codes primarily.
The latest updates are available on CMS.gov or through tools like the AMA HCPCS Lookup.
They now require full documentation of both programming and clinical evaluation—partial submissions have been denied.
Yes. Modifier 95 is for audio-video. Modifier 93 is for audio-only. Missing them is a leading cause of denials.
Monthly reviews are now being recommended to stay aligned with updates from Medicare, UnitedHealthcare, and other payers.
External Resource: Neurology Billing Trends 2025 – Becker’s Hospital Review
If neurology billing audits or increased denial rates are being struggled with, help is available from expert billing partners familiar with neurology requirements.
Your Path to Clean Neurology Claims Starts Here
Streamline coding processes
Fix modifier and telehealth claim mistakes
Improve clean claim rates
Train staff on 2025 updates
👉 Stay ahead of audits and denials—let your neurology billing process work smarter, not harder.
to move toward faster reimbursements and fewer denials.
