Appeal type: Imaging
Decision: Unfavorable

 
We decided that the Plan does not have to pay for needle electromyography (95885), nerve conduction studies 
(95907), somatosensory evoked potential study (95927), neuromuscular junction testing (95937), and 
electroencephalogram (95955) provided on May 7, 2021. 
You asked the Plan to pay for needle electromyography, nerve conduction studies, somatosensory evoked 
potential study, neuromuscular junction testing, and electroencephalogram. You say that records to support the 
billed services have been provided. The Plan denied your request. The Plan says the provided records do not 
support the services billed. 
 
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 95885 is "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)"; the definition of code 95907 is "Nerve 
conduction studies; 1-2 studies"; the definition of code 95927 is "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"; the definition of code 95937 is "Neuromuscular junction testing (repetitive stimulation, paired 
stimuli), each nerve, any 1 method"; and 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 needle electromyography, nerve conduction studies, 
somatosensory evoked potential study, neuromuscular junction testing, and electroencephalogram. Our 
reviewer says that the codes at issue do not meet criteria for payment. Our reviewer found that the procedure 
report describes pedicle screw stimulation, which would not be reported with nerve conduction study procedure 
codes. Nerve conduction measures amplitude and latency/velocity study. Therefore, CPT code 95907 would 
not be covered. Electromyography is done with nerve conduction studies. In this case nerve conduction studies 
cannot be verified by documentation; therefore, the documentation does not support code 95885. The 
procedure report does not include documentation of neuromuscular junction testing (95937) or of 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 (95927). The procedure report records that real-time 
electroencephalogram (EEG) monitoring was done, which is not covered by code 95955. Per CPT assistant, a 
more specific CPT code exists for establishing an EEG baseline. Additional EEG monitoring would be 
included in the intraoperative neuromonitoring code. CPT code 95955 is not supported by the clinical 
documentation. 
 
We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of needle electromyography, nerve conduction studies, somatosensory evoked 
potential study, neuromuscular junction testing, and electroencephalogram have not been met. Therefore, we 
decided that the Plan does not have to pay for needle electromyography (95885), nerve conduction studies 
(95907), somatosensory evoked potential study (95927), neuromuscular junction testing (95937), and 
electroencephalogram (95955) provided on May 7, 2021.