Appeal type: Testing
Decision: Unfavorable

 
We decided that the Plan does not have to pay for procedure codes 95908, 95886, 95937, and 95955 provided 
on June 1, 2022. 
 You asked the Plan to pay for procedure codes 95908, 95886, 95937, and 95955. You say that the medical 
records support the billing of codes 95908, 95886, 95937, and 95955. The Plan denied your request. The Plan 
says the medical records do not support the billing of codes 95908, 95886, 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 95908 is Nerve conduction studies; 3-4 studies. The 
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 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 procedure codes 95908, 95886, and 95937. Our reviewer 
says that the medical records do not support the billing of codes 95908, 95886, and 95937. Our reviewer found 
in this case the member underwent Intraoperative neuromonitoring (IONM). Nerve conduction studies are not 
generally done intraoperatively. Rather code 95908 was submitted for triggered EMG testing of pedicle screw 
stimulation. The guidance for billing of this service has long stated: For pedicle screw stimulation, the 
individual performing the intraoperative electrophysiologic monitoring is usually evaluating Free Run and 
triggered electromyography. (The triggered electromyography is when the pedicle screw is stimulated)". As a 
nerve conduction study (NCS) was not done during this surgery code 95908 would not have been correctly 
billed. 
 
NCS was not done during surgery. As such code 95886 would not be the most appropriate CPT code. The 
records ultimately do not support performance of all aspects of this code's definition. 
 
The medical records do not support code 95937. Train of four testing was performed. This is distinct from 
95937 which is reserved for use in coding testing of the neuromuscular junction (NMJ) done to diagnose for 
neuromuscular disorders. A peripheral nerve stimulator, also known as a train-of-four monitor, is used to assess 
neuromuscular transmission when neuromuscular blocking agents are given to block musculoskeletal activity. 
By assessing the depth of neuromuscular blockade, peripheral nerve stimulation can ensure proper medication 
dosing and, thus, decrease the incidence of side effects. Train-of-four monitoring is bundled with the 
intraoperative neuromonitoring of electromyography (EMG) or motor evoked potentials (MEP) and, therefore, 
is not separately reportable.  
 
Furthermore, per the Physician Fee Schedule, code 95955 has a Professional/Technical indicator of 1. This 
means that code 95955 has both a professional and technical component. In this case, code 95955 has not been 
billed with an appropriate modifier to indicate the professional component. 
 
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 95908, 95886, 95937, and 95955 have not been met. 
Therefore, we decided that the Plan does not have to pay for procedure codes 95908, 95886, 95937, and 95955 
provided on June 1, 2022.