Appeal type: Practitioner Services
Decision: Partially Favorable

 
We decided that the Plan has to pay for 95886. We decided that the Plan does not have to pay for 95908, 
95937, 95939.  
 
You asked the Plan to pay for neurology services (procedure codes 95886, 95908, 95937, 95939) provided to 
the enrollee on September 1, 2022.. You say that this should be paid for. The Plan says that the records do not 
support the services billed 
 
 
 We decided that the Plan has to pay for 95886.  
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request for CPT 95886.  
 
Our reviewer says that in terms of CPT 95886, the technical report states that the sites for the 
electromyography were ADM, APB, biceps, deltoids, trapezius, and triceps. This supports that 6 sites were 
used. Therefore, the records support the use of this code and that it was rendered. 
 
We looked at this physician's review, the file and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the services have been met. Therefore, we decided that the Plan has to pay for 
95886.  
 
We also decided that the Plan does not have to pay for 95908, 95937, 95939. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request for CPT 95908 and CPT 95939.  
 
Our reviewer says that in terms of CPT 95908, the technical report states sensory nerve action potential 
(SNAP) nerve conduction study 3-4 had recording sites of Erb's point. Despite the report saying 3-4 sites, the 
only recording site noted is Erbs point. Therefore, the records do not support that CPT 95908: nerve 
conduction studies, 3-4 studies were rendered in this case. 
 
Our reviewer found that in terms of CPT 95939, the upper MEP (motor evoked potentials) had recording sites 
of ADM muscle, APB muscle, biceps muscle, and triceps muscle. The lower MEP recording sites had flexor 
hallucis brevis and tibialis anterior. However, there is no indication of any transcranial motor stimulation. 
Therefore, the records do not support that CPT 95939: central motor evoked potential study (transcranial motor 
stimulation), in upper and lower limbs was rendered in this case. 
 
Additionally, CPT 95937 did not require review. The records show that train of four testing was performed. 
Coding guidelines specify that train of four testing cannot be reported separately. 
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of 95908, 95937, 95939 have not been met. Therefore, we decided that the Plan 
does not have to pay for 95908, 95937, 95939. 
 
If the Plan does not agree with our decision, they can ask us to open a case again. We only open a case again 
if we believe there was a mistake or if there is new information to review. The Plan has to show us the mistake 
and/or send us the new information. This does not happen often. If we decide to open the case again, we will 
send you a letter.