Appeal type: Practitioner Services
Decision: Unfavorable

 
We decided that the Plan does not have to pay for procedure codes 95886, 95908, 95937, and 95955 provided 
on October 31, 2022. 
 
You asked the Plan to pay for procedure codes 95886, 95908, 95937, and 95955. You say that the medical 
records support the billing of codes 95886, 95908, 95937, and 95955 The Plan denied your request. The Plan 
says the medical records do not support the billing of codes 95886, 95908, 95937, and 95955 
 
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 95908 is Nerve conduction 
studies; 3-4 studies. The definition of code 95937 is Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method. The definition of code 95955 is Electroencephalogram (EEG) during 
nonintracranial surgery (eg, carotid surgery). 
 
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 procedure codes 95886, 95908, 95937, and 95955. Our 
reviewer says that the medical records do not support the billing of codes 95886, 95908, 95937, and 95955. 
Our reviewer found procedure code 95886-26-59 x2 is not supported by the medical records submitted. The 
technical report did not include documentation of a complete needle electromyography, per each extremity with 
related paraspinal areas when performed, done with nerve conduction, amplitude, and latency/velocity study; 
for five or more muscles studied, innervated by three or more nerves or four or more spinal levels (listed 
separately in addition to code for primary procedure); therefore, this code cannot be verified. Procedure code 
95908-26 is not supported in the documentation therefore is not payable. Regarding the submitted code of 
95937-26, 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. Procedure 95937 has both 
a technical and professional component. To claim only the professional component, append modifier 26. To 
claim only the technical component, append modifier TC. To claim the complete procedure (i.e., both the 
professional and technical components), submit without a modifier. Code 95937-26 is not supported in the 
documentation. Procedure code 95955 was created for the service of sending a senior electroencephalogram 
(EEG) technologist to the operating room to run the recording, with the physician reading the record after the 
recording has taken place. The neurophysiology monitoring report describes real time interpretation of an EEG 
when a patient is not awake during the recording. The requested code is being used to represent Train of four. 
Per CPT instructions, Train of four when performed during intraoperative neurophysiological monitoring 
(IONM) is inclusive to the IONM, whether the IONM is primarily electromyography (EMG) based or maximal 
expiratory pressure (MEP) based. In this case, the requested procedure code is not substantiated by the clinical 
documentation in the technical report submitted for review. 
 
We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of procedure codes 95886, 95908, 95937, and 95955 have not been met. 
Therefore, we decided that the Plan does not have to pay for procedure codes 95886, 95908, 95937, and 95955 
provided on October 31, 2022.