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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that A. Nerve Conduction Studies 
 
            The dichotomy into axonal and demyelinating neuropathies provides a practical means of correlating 
electrical abnormalities with major pathophysiologic changes in the nerve. Electrical studies can be of help in 
localization of an abnormality, and in distinguishing one variety of neuropathy from another: for example, 
diffuse vs. multifocal; axonal vs. demyelinating. Such distinction has diagnostic value. Specific classification 
of nerve injuries into neuropraxia and axonotmesis can be made on the basis of conduction studies and 
electromyography. Such classification has a bearing on prognosis and treatment.  
 
            1. Focal neuropathies or compressive lesions such as carpal tunnel syndrome, ulnar neuropathies or root 
lesions, for localization. 
            2. Traumatic nerve lesions, for diagnosis and prognosis. 
            3. Diagnosis or confirmation of suspected generalized neuropathies, such as diabetic, uremic, metabolic 
or immune. 
            4. Repetitive nerve stimulation in diagnosis of neuromuscular junction disorders such as myasthenia 
gravis, myasthenic syndrome. 
            5. There may be other instances, not detailed here, where NCS may be of use. Not all possible or 
potential indications are addressed here. 
 
"The stimulation of nerves is similar across all NCSs; the characteristics of motor, sensory, and mixed NCSs 
are different and are discussed separately below. In each case, an appropriate nerve is stimulated and recording 
is made either from the appropriate nerves or from muscle supplied by the motor nerve. 
 
            a. Motor NCSs are performed by applying electrical stimulation at various points along the course of a 
motor nerve while recording the electrical response from an appropriate muscle. Response parameters include 
amplitude, latency, configuration, and motor conduction velocity. 
            b. Sensory NCSs are performed by applying electrical stimulation near a nerve and recording the 
response from a distant site along the nerve. Response parameters include amplitude, latency, and 
configuration. 
            c. Mixed NCSs are performed by applying electrical stimulation near a nerve containing both motor and 
sensory fibers (a mixed nerve) and recording from a different location along that nerve that also contains both 
motor and sensory nerve fibers. Response parameters include amplitude, latency, configuration, and motor 
conduction velocity." 
 
Nerve conduction studies performed independent of needle electromyography (EMG) may only provide a 
portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. When the nerve 
conduction study (NCS) is used on its' own without integrating needle EMG findings or when an individual 
relies solely on a review of NCS data, the results can be misleading, and important diagnoses may be missed. 
 
In most instances, both NCS and usually EMG are necessary to perform diagnostic testing. While a provider 
may choose to perform just an NCS, when performed alone it is usually considered not medically necessary. 
 
 
The only exception to this is a situation when a provider may consider it appropriate to perform an NCS 
without doing an EMG for the diagnosis of carpal tunnel syndrome with a high pre-test probability. 
 
B. Electromyography 
 
Neurogenic disorders can be distinguishable from myopathic disorders by a carefully performed EMG. For 
example, both polymyositis and ALS produce manifest weakness. The former carries a very different prognosis 
and treatment than the latter. An EMG is valuable in making this distinction. Similarly, classification of nerve 
trauma into axonal vs. demyelinating categories, with corresponding differences in prognoses, are possible with 
EMG. Below is a list of common disorders where an EMG, in tandem with properly conducted NCS, will be 
helpful in diagnosis:  
 
            1. Nerve compression syndromes, including carpal tunnel syndrome and other focal compressions. 
            2. Radiculopathy - cervical, lumbosacral. 
            3. Mono/polyneuropathy - metabolic, degenerative, hereditary. 
            4. Myopathy - including poly-and dermatomyositis, myotonic and congenital myopathies. 
            5. Plexopathy - idiopathic, trauma, infiltration. 
            6. Neuromuscular junction disorders - myasthenia gravis. Single fiber EMG is of special value here. 
           7. At times, immediately prior to botulinum toxin injection, for localization. 
            8. At times, immediately prior to injection of phenol or other substances for nerve blocking or 
chemodenervation. 
 
There may be other instances, not detailed here, where EMG may be of use. 
 
Limitations: 
  
Routine testing for polyneuropathy of diabetes or end stage renal disease (ESRD) is not considered medically 
necessary and is not covered. Testing for the sole purpose of monitoring disease intensity or treatment efficacy 
in these two conditions is also not covered. 
 
Psychophysical measurements (current, vibration, thermal perceptions), even though they may involve delivery 
of a stimulus, are considered to be part of the physical exam and may not be billed as a separate service. 
 
Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT) ? is not covered by Medicare. 
This procedure is different and distinct from assessment of nerve conduction velocity, amplitude and latency. It 
is also different from short-latency somatosensory evoked potentials. 
 
Examination using portable hand-held devices, or devices which are incapable of real-time wave-form display 
and analysis, and incapable of both NCS and EMG testing; will be included in the E/M service. They will not 
be paid separately. Examples include: The Axon II or delta fiber analysis testing and/or machines with other 
names. 
 
NCS must provide a number of response parameters in a real-time fashion to facilitate provider interpretation. 
Those parameters include amplitude, latency, configuration and conduction velocity. Medicare does not accept 
diagnostic studies that do not provide this information or those that provide delayed interpretation as substitutes 
for NCS. Raw measurement data obtained and transmitted trans-telephonically or over the Internet, therefore, 
do not qualify for the payment of the electrodiagnostic service codes included in this LCD. 
 
Medicare does not expect to receive claims for nerve conduction testing accomplished with discriminatory 
devices that use fixed anatomic templates and computer-generated reports used as an adjunct to physical 
 
 
examination routinely on all patients. 
 
Electromyography 
The necessity and reasonableness of the following uses of EMG studies have not been established: 
 
        exclusive testing of intrinsic foot muscles in the diagnosis of proximal lesions  
        definitive diagnostic conclusions based on paraspinal EMG in regions bearing scar of past surgeries (e.g., 
previous laminectomies)  
        pattern-setting limited limb muscle examinations, without paraspinal muscle testing for a diagnosis of 
radiculopathy  
        EMG testing shortly after trauma, before EMG abnormalities would have reasonably had time to develop  
        surface and macro EMGs  
        multiple uses of EMG in the same patient at the same location of the same limb for the purpose of 
optimizing botulinum toxin injections. 
 
You can find this information in Medicare's Local Coverage Determination (LCD): Nerve Conduction Studies 
and Electromyography (L36524). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.