Appeal type: Imaging
Decision: Unfavorable

 
We decided that the Plan does not have to pay for the medical services provided on December 2, 2021, billed 
with procedure codes 95937, 95927, 95907, 95886, and 95822. 
 
You asked the Plan to pay for the medical services. You say that the claim should be paid as billed The Plan 
denied your request. The Plan says some of the billed services were approved on the appeal; however, 
procedure codes 95937, 95927, 95907, 95886, and 95822 remain not supported. 
 
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 procedure codes 95937, 95927, 95907, 95886, and 95822 
is neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method, 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, nerve conduction studies; 1-2 studies, 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), and 
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 medical services. Our reviewer says that the 
documentation does not support procedure codes 95937, 95927, 95907, 95886, and 95822. Our reviewer found 
that regarding procedure code 95937, the medical records provide do not include sufficient documentation to 
validate that Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method 
was performed on December 2, 2021, therefore this procedure cannot be verified.  
 
Regarding procedure code 95927, the medical records provided do not include sufficient documentation to 
validate that 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 was performed on December 2, 
2021, therefore this procedure cannot be verified. The medical records indicate the ulnar nerve was stimulated 
with recording at the punctum nervosum, also known as Erb's point, which is inclusive to the somatosensory 
evoked potentials (SSEP) performed during this same operative session. 
 
 Regarding procedure code 95907, the medical records provided do not include sufficient documentation to 
validate that a Nerve conduction studies; 1-2 studies was performed on December 2, 2021, therefore this 
procedure cannot be verified.  
 
Regarding procedure code 95886, the medical records provided do not include sufficient documentation to 
validate that a 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) was performed on December 2, 2021, therefore this procedure cannot be verified.  
 
Lastly, regarding procedure code 95822, the medical records provided do not include sufficient documentation 
to describe an Electroencephalogram (EEG); recording in coma or sleep only being performed on December 2, 
2021, therefore this procedure cannot be verified.  
 
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 medical services have not been met. Therefore, we decided that the Plan 
does not have to pay for the medical services provided on December 2, 2021, billed with procedure codes 
95937, 95927, 95907, 95886, and 95822.