Neurology Billing Services in Maryland
Maryland's neurology practices face unique billing challenges shaped by CareFirst BlueCross BlueShield's commercial rules, Maryland Medicaid (HealthChoice managed care program) requirements, and Novitas Solutions (Jurisdiction L) Medicare policies. Our AAPC-certified coders specialize in both MD payer rules and neurology coding complexity.
Why Maryland Neurology Practices Need Specialized Billing
Maryland's healthcare market includes 22,000+ physicians, and neurology practices here face a payer market dominated by CareFirst BlueCross BlueShield on the commercial side and Maryland Medicaid (HealthChoice managed care program) on the public payer side. Medicare claims are processed through Novitas Solutions (Jurisdiction L), which applies its own Local Coverage Determinations that directly affect neurology procedure coverage and medical necessity requirements. Generic billing teams without MD specific knowledge leave revenue on the table.
Neurology billing itself is complex. Neurology diagnostic testing codes have professional and technical components, time-based elements, and study-specific documentation requirements. EMG/NCS (95907-95913, 95885-95886) requires documenting specific nerves tested. EEG (95816-95822) has awake, sleep, and long-term monitoring variants. When you combine this coding complexity with Maryland's specific payer rules, authorization requirements, and 9 Maryland Medicaid (HealthChoice managed care program) managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving neurology practices from Baltimore to Frederick and across Maryland.
2026 Maryland Medicare Allowables for Neurology CPT Codes
These are the 2026 Medicare allowable amounts for neurology CPT codes in Maryland, processed under Novitas Solutions (Jurisdiction L). Allowables are locality-adjusted, so MDrates differ from other states — the highest-value neurology code below pays $700.22 non-facility here. Compare any code across states with our Medicare fee calculator by state.
Source: 2026 Medicare Physician Fee Schedule, MD locality (Novitas Solutions (Jurisdiction L)). Commercial CareFirst BlueCross BlueShield rates typically run above these benchmarks; Maryland Medicaid (HealthChoice managed care program) rates run below. Figures for reference, not a guarantee of payment.
The Maryland Market Context for Neurology Practices
Maryland has about 22,000 physicians and the most unusual hospital reimbursement structure in the country. Under a federal waiver, the Maryland Health Services Cost Review Commission sets hospital rates that apply equally to all payers including Medicare, Medicaid, commercial insurers, and self-pay patients. This means a Maryland hospital charges the same rate for the same service regardless of payer. The All-Payer Model has been in place in some form since 1977 and was renewed as the Total Cost of Care Model in 2019. The HealthChoice Medicaid managed care program runs through nine MCOs, including unique provider-based plans like Priority Partners (Johns Hopkins HealthCare) and MedStar Family Choice (MedStar Health). The Baltimore-Washington corridor concentrates most of the state's physicians, with Johns Hopkins, MedStar Health, and University of Maryland Medical System as the three anchor academic systems. Maryland's Medicaid program ran a 2024 health equity incentive program that distributed payments based on socioeconomic disadvantage scores across the state.
Maryland-specific factors that shape neurology reimbursement: Maryland is the only state with an All-Payer Model under federal waiver. Hospital rates are set by the Health Services Cost Review Commission and apply equally to Medicare, Medicaid, commercial, and self-pay. The model has been in place since 1977 and was renewed as the Total Cost of Care Model in 2019.; Maryland's HealthChoice program runs through nine MCOs, including provider-owned plans like Priority Partners (Johns Hopkins HealthCare) and MedStar Family Choice (MedStar Health). This is more provider-affiliated MCOs than any other state.; The 2024 HealthChoice agreement allocated health equity incentive payments ranging from about $226,000 for Aetna to about $2.2 million for Priority Partners, based on MCO membership in jurisdictions with the highest socioeconomic disadvantage scores.. Our MD coders build these into every neurologyclaim — see how this works alongside our Maryland medical billing and neurology billing teams.
Maryland Payer Challenges for Neurology
Every MD payer has specific rules for neurology claims. Here's how we navigate them.
CareFirst BlueCross BlueShield Neurology Claims
CareFirst BlueCross BlueShield processes the largest share of Maryland commercial neurology claims. We know their MD specific fee schedules, prior authorization requirements for neurology procedures, and their appeal timelines when claims are denied. Nerve conduction and needle EMG have separate code families that must be coordinated.
Maryland Medicaid (HealthChoice managed care program) Neurology Billing
Maryland Medicaid (HealthChoice managed care program) routes neurology patients through 9 managed care plans: Aetna Better Health of Maryland, CareFirst BlueCross BlueShield Community Health Plan Maryland, Jai Medical Systems, and 6 more. Each MCO has its own neurology authorization and billing rules that we manage.
Medicare (Novitas Solutions (Jurisdiction L)) Neurology Coverage
Novitas Solutions (Jurisdiction L) processes Medicare neurology claims in Maryland with its own Local Coverage Determinations. We navigate Novitas Solutions (Jurisdiction L)'s policies around eeg variant selection to prevent medical necessity denials.
Denial Prevention for Maryland Neurology
Common neurology denials in Maryland include nerve conduction and needle emg have separate code families that must be coordinated and routine, extended, ambulatory, and video eeg each have different codes and documentation. Our team catches these issues before submission and appeals aggressively with MD payer-specific documentation when denials occur.
Get Expert Neurology Billing in Maryland
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What We Handle for Maryland Neurology Practices
Maryland Neurology Billing Cost Comparison
Hiring an in-house biller with neurology expertise in Maryland costs $42K-$55K annually in salary alone. Add benefits, software, clearinghouse fees, and office space, and the true cost is even higher. At 2.49% of collections, Go Medical Billing provides an entire team of AAPC-certified neurology coders and MD payer specialists for a fraction of that cost.
$42K-$55K
In-House Biller Salary
+ benefits, software, space
2.49%
Go Medical Billing Rate
Full team, all services included
60-80%
Typical Cost Reduction
With better results
Related Pages
Explore our Maryland and neurology billing resources.
Frequently Asked Questions
Fix Your Maryland Neurology Billing
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