Appeal type: Practitioner Services
Decision: Favorable

 
We decided that the Plan has to pay for procedure codes 95885, 95907, 95927, 95937 and 95955 rendered on 
August 17, 2021. 
 
You asked the Plan to pay for the services. You say that this should be paid for. The Plan denied your request. 
The Plan says that the 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 
the denied codes is: 
 
CPT 95885: 
 
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) 
 
CPT 95907: 
 
Nerve conduction studies; 1-2 studies 
 
CPT 95927: 
 
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 
 
CPT 95937: 
 
Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method 
 
CPT 95955: 
 
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 the services. Our reviewer says that the services at issue in 
this case were supported by the medical records.  
 
Our reviewer found that in terms of CPT 95886, the procedure details cite electromyography recording sites 
were abductor hallucis, gastroc S1, tibialis anterior, vastus medialis, and vastus lateralis. Therefore, the records 
support this code. 
 In terms of CPT 95907, the procedure details cite nerve conduction velocity recording sites Erbs point and 
popliteal fossa. Therefore, the records support this code. 
 
In terms of CPT 95927, the procedure details cite upper somatosensory evoked potential stimulation sites 
include the ulnar nerve and the lower somatosensory evoked potential stimulation site was the posterior tibial. 
Therefore, the records do support this code. 
 
In terms of CPT 95937, the procedure details cite pedicle testing was performed at L4 and L5 bilaterally. Train-
of-four testing was performed. Therefore, the records do support this code. 
 
Finally, in terms of CPT 95955, the procedure details cite an electroencephalogram was performed throughout 
the procedure. Therefore, the records do support this code. 
 
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 services have been met. Therefore, we decided that the Plan has to pay for 
procedure codes 95885, 95907, 95927, 95937 and 95955 rendered on August 17, 2021.  
 
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.