Billing and Coding: Nerve Conduction Studies and Electromyography

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Nerve Conduction Studies and
Electromyography.

**National Coverage Provisions:**

**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. Codes
designated for eliciting nerve conduction velocity, latency or amplitude, and
those designed for short latency evoked potentials are not to be used for
sNCT. The sNCT has a unique code G0255: Effective October 1, 2002, CMS
initially concluded that there was insufficient scientific or clinical
evidence to consider the sNCT test and the device used in performing this test
reasonable and necessary within the meaning of section 1862(a)(1)(A) of the
law. Therefore, sNCT was noncovered. Based on a reconsideration [in March,
2004] of current Medicare policy for sNCT, CMS concludes that there continues
to be insufficient scientific or clinical evidence to consider the sNCT test
and the device used in performing this test as reasonable and necessary within
the meaning of section 1862(a)(1)(A) of the law. CMS Publication 100-3,
Medicare National Coverage Determinations Manual,_ Chapter 1, Section 160.23.

**Coding Information:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.  
 **  
**

**Specific Coding Guidelines:**



**Physical Therapists Performing EMGs**

Program Memorandum Transmittal B-01-28/Change Request 850 sets forth revised
levels of physician supervision required for diagnostic tests payable under
the Medicare Physician Fee Schedule. Effective July 1, 2001, certain codes in
the range of CPT 95860-95937 were assigned new supervision levels (21, 22, 6a,
66, 77 or 77a). This implementation date would make it possible for physical
therapists to acquire the certification required to perform these services
without supervision. A physical therapist who is presently certified by the
American Board of Physical Therapy Specialties can perform procedures assigned
level of 21, 22, 66, 6a, 77, or 77a without supervision. These numeric levels
assigned to the CPT codes are listed in the Medicare Physician Fee Schedule
Database (MFSDB). _Physical therapists who do not possess the ABPTS (American
Board of Physical Therapy Specialties) certification by July 1, 2001, may
continue to furnish those tests that require the certification if they have
been furnishing such diagnostic tests prior to May 1, 2001._

Payment will be based on the Medicare Physician Fee Schedule level of
supervision designation.

Nerve conduction code 95905 does not have one of the above designations and is
therefore not allowed by Physical Therapists.

Nerve conduction codes 95907-95913 had their Physician Supervision of
Diagnostic Procedures Indicators adjusted to 7A effective 01/01/2013 (CR
8169). Please refer to the description of 7A below. Therefore if authorized by
state law Physical Therapists are allowed the technical portion and
professional component of the test.

The technical component (TC) of the Neuromuscular junction testing code 95937
had its Physician Supervision of Diagnostic Procedures Indicator changed to
"7A" This change is effective January 1, 2013.

"7A" = "Supervision standards for level 77 apply; in addition, the PT with
ABPTS certification may personally supervise another PT, but only the PT with
ABPTS certification may bill."

"77" = "Procedure must be performed by a PT with ABPTS certification (TC & PC)
or by a PT without certification under direct supervision of a physician (TC
only; PC always physician)". These changes are effective January 1, 2013.

Needle electromyographic (EMG) codes 95860-95872 and 95885-95887 have the
designation of 6A. Please refer to the description below. If authorized by
state law and if meeting certification criteria, Physical Therapists are
allowed the technical and professional components of the test.

6A = Supervision standards for level 66 apply; in addition, the PT with ABPTS
certification may personally supervise another PT, but only the PT with ABPTS
certification may bill.

66 = May be personally performed by a physician or by a physical therapist
with ABPTS certification and certification in this specific procedure.

**Nerve Conduction Studies**

When the beneficiary has a high pre-test or a prior probability for having the
diagnosis of Carpal Tunnel Syndrome, the NC-stat System (alone) will be
allowed, one service per arm, using CPT code 95905. ICD-10 codes G56.01,
G56.02, or G56.03 should be used.

**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.

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.

**Electromyography**

It is expected that providers will use CPT code 95870 for sampling muscles
other than the paraspinals associated with the extremities, which have been
tested. Medicare would not expect to see this code billed when the paraspinal
muscles corresponding to an extremity are tested and when the extremity EMG
code 95860, 95861, 95863 or 95864 is also billed.

**Documentation Requirements**

The patient's medical records must clearly document the medical necessity for
the test. It is not necessary to include documentation with each claim
submission. Data gathered during NCS, however, should be available which
reflect the actual numbers (latency, amplitude, etc.), preferably in a tabular
(not narrative) format. The reason for referral and a clear diagnostic
impression are required for each study. In cases where a review becomes
necessary, either a hard copy of waveforms or a complete written report with
an interpretation of the test must be submitted upon request.

Normal findings and abnormalities uncovered during the study should be
documented with the muscles tested, the presence and type of spontaneous
activity, as well as the characteristics of the voluntary unit potentials and
interpretation.

**Utilization Guidelines**

**Nerve Conduction Studies**

Each descriptor (code) from codes 95907, 95908, 95909, 95910, 95911, 95912,
and 95913, can be reimbursed only once per nerve, or named branch of a nerve,
regardless of the number of sites tested or the number of methods used on that
nerve. For instance, testing the ulnar nerve at wrist, forearm, below elbow,
above elbow, axilla and supraclavicular regions will all be considered as a
single nerve. Motor and sensory nerve testing are considered separate tests.
CPT code 95905 is payable only once per limb studied and cannot be used in
conjunction with any other nerve conduction codes.