Appeal type: Practitioner Services
Decision: Unfavorable

 
We decided that the Plan does not have to pay for the testing services provided on January 12, 2022. 
 
You asked the Plan to pay for the testing services. You say that the documentation supports payment for the 
services billed. The Plan denied your request. The Plan says the documentation does not support payment 
based on the technical report. 
 
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 the billed codes are as follows: 
 
95939 -  Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs  
95937 -  Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method  95938 -  Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin 
sites, recording from the central nervous system; in upper and lower limbs  
95908 -  Nerve conduction studies; 3-4 studies  
95885 -  Needle electromyography, each extremity, with related paraspinal areas, when performed, done with 
nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary 
procedure)  
95927 -  Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin 
sites, recording from the central nervous system; in the trunk or head  
95822 -  Electroencephalogram (EEG); recording in coma or sleep only 
 
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 the testing services. Our reviewer says that the 
documentation does not support payment for the testing services as they are billed. Our reviewer found the 
following: 
 
CPT 95937: The procedure describes train-of-four neuromuscular junction testing as one procedure. This 
resulted in incorrect billing for the services rendered. 
 
CPT 95908: The procedure report describes "pedicle screw stimulation.  Nerve conduction codes are incorrect 
codes to report for this procedure. 
 
CPT 95885: Per the CPT code description this procedure is "done with" nerve conduction studies.  In this case, 
nerve conduction studies cannot be verified; therefore, this procedure would not be covered. 
 
CPT 95927: The procedure report describes ulnar nerve stimulated with recording at Erb's point. Per codify "In 
this procedure, the provider performs a short-latency somatosensory evoked potential study by stimulating the 
peripheral nerves or skin sites in the trunk or head. The provider records the resulting evoked potential study 
from the central nervous system".  In this case, this procedure code cannot be verified. 
 
CPT 95822: The procedure report does not include documentation of a diagnostic EEG. Therefore, this service 
cannot be verified. The procedure report describes continuous EEG monitoring. 
 
We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the testing services have not been met. Therefore, we decided that the Plan does 
not have to pay for the testing services provided on January 12, 2022.