Appeal type: Lab
Decision: Unfavorable

 
We decided that the Plan does not have to pay for the neuromonitoring services (95886, 95907, and 95937) 
provided on March 21, 2022. 
 
You asked the Plan to pay for codes 95886, 95907, and 95937. You say that the medical records support the 
billing of codes 95886, 95907, and 95937 provided on March 21, 2022. The Plan denied your request. The Plan 
says the medical records do not support the billing of codes 95886, 95907, and 95937 provided on March 21, 
2022. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 In this case, the CPT Code Manual definition of code 95886 is Needle electromyography, each extremity, with 
related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; 
complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (List 
separately in addition to code for primary procedure). The definition of code 95907 is Nerve conduction 
studies; 1-2 studies. The definition of code 95937 is Neuromuscular junction testing (repetitive stimulation, 
paired stimuli), each nerve, any 1 method. 
 
We asked our coder to carefully review the case file and apply the relevant Medicare rules to determine if the 
Plan was correct in denying the request to pay for codes 95886, 95907, and 95937. Our reviewer says that the 
medical records do not support the billing of codes 95886, 95907, and 95937 provided on March 21, 2022. Our 
reviewer found the documentation submitted was reviewed, and the records do not support the billing of code 
95886.  Per CPT 95886 "done with nerve conduction, amplitude and latency/velocity study" cannot be verified, 
as the procedure report does not describe nerve conduction studies.  The documentation submitted was 
reviewed, and the records do not support the billing of code 95907. The technical report describes pedical 
screw stimulation and are not considered nerve conduction studies measure amplitude and latency/velocity 
study. The procedure report documents "Pedical screw placement was evaluated via stimulated EMG". In this 
case, nerve conduction studies 1-2 studies cannot be verified. The documentation submitted was reviewed, and 
the medical records do not support the billing of code 95937.  The procedure report documents "Train-of-Four 
Neuromuscular Junction (TO4) testing".  TO4 is not considered Neuromuscular Junction testing. TO4 testing is 
inclusive to neuromonitoring procedure code and would not be reported separately. The procedure report does 
not include documentation to support (Per NCCI Policy) "The physician uses sensors to measure and record 
nerve functions such as conduction and amplitude. This code applies to measure the junction between nerves 
and muscles for one nerve". 
 
We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of codes 95886, 95907, and 95937 have not been met. Therefore, we decided that 
the Plan does not have to pay for the neuromonitoring services (95886, 95907, and 95937) provided on March 
21, 2022.