Appeal type: Practitioner Services
Decision: Unfavorable

 
We decided that the Plan does not have to pay for procedure codes 95885, 95909, 95927, 95937, and 95955 
provided on August 4, 2021. 
 
You asked the Plan to pay for procedure codes 95885, 95909, 95927, 95937, and 95955. You say that the 
medical records support the billing of codes 95885, 95909, 95927, 95937, and 95955.  The Plan denied your 
request. The Plan says the medical records do not support the billing of codes 95885, 95909, 95927, 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 95885 is 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). The definition of code 95909 is Nerve 
conduction studies; 5-6 studies. The definition of code 95927 is 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. The definition of code 95937 is Neuromuscular junction testing (repetitive stimulation, paired 
stimuli), each nerve, any 1 method. The definition of code 95955 is 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 procedure codes 95885, 95909, 95927, 95937, and 95955. 
Our reviewer says that the medical records do not support the billing of codes 95885, 95909, 95927, 95937, 
and 95955.  Our reviewer found code 95955 is not supported. The record states that the electroencephalogram 
(EEG) was used for intraoperative monitoring, not a diagnostic procedure. There is a more appropriate way to 
report this service. Code 95927 is not supported. The record states that somatosensory evoked potentials 
(SSEP) was performed on the extremities; there is no mention of SSEP of the trunk or head. Code 95937 is not 
supported. The record states that train of four was reported as neuromuscular junction testing. Train of four is 
included in intraoperative neuromonitoring and not separately reportable, according to coding rules. Code 
95909 is not supported. The record mentions pedicle screw placement and stimulation, which is not nerve 
conduction studies. Nerve conduction studies require electrodes with amplitude, latency, and configuration of 
stimulus. This is not documented in the record. Code 95885 is not supported. The record does not support that 
needle electromyography (EMG) with nerve conduction studies was performed. 
 
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 95885, 95909, 95927, 95937, and 95955 have not been met. 
Therefore, we decided that the Plan does not have to pay for procedure codes 95885, 95909, 95927, 95937, and 
95955 provided on August 4, 2021.