Billing and Coding: Nerve Conduction Studies and Electromyography

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Nerve Conduction
Studies and Electromyography L35048.

**Physical Therapists Performing Electromyography (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.

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

Nerve conduction CPT code 95905 does not have 1 of the above designations and
is therefore not allowed by Physical Therapists (PTs).

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

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

Needle EMG CPT codes 95860-95872 and 95885-95887 have the designation of 6A
for the technical portion of the test. Therefore, if authorized by state law
PTs who are presently certified by the ABPTS as a qualified electrophysiologic
clinical specialist are allowed the technical portion and the professional
component of the test according to the description of 6A.

**Nerve Conduction Studies (NCS)**

CPT code 95905 - Nerve conduction studies performed using automated devices
(for example devices such as NC-stat System) cannot support testing of other
locations and other nerves as needed, depending on the concurrent results of
testing, and they should not be billed to Medicare with the current CPT
codes.

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, 1 service per arm, using CPT code 95905. The diagnosis code G56.01
or G56.02 should be used. All other diagnosis codes will be denied as not
medically necessary.

**_Limitations:_**

**Nerve Conduction Studies**

Each descriptor (code) from CPT 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.

**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.

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, does not
qualify for the payment of the ED service codes included in this article.

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**

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
CPT code 95860, 95861, 95863 or 95864 is also billed.

It is not necessary to include documentation with each claim submission. Data
gathered during NCS, however, should be available.