Article - Billing and Coding: Nerve Conduction Studies and Electromyography (A56619)

CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Transmittal 2677, Change Request 8169, dated March 26, 2013.Article TextThe 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 CPTcode 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 CPTcode 95937 had its Physician Supervision of Diagnostic Procedures Indicator changed to 7A. This change is effective January 1, 2013.Needle EMG CPTcodes 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)CPTcode 95905 - Nerve conduction studies performed using automated devices (for example devices such as NC-statSystem) 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 CPTcodes.When the beneficiary has a high pre-test or a prior probability for having the diagnosis of carpal tunnel syndrome, the NC-statSystem (alone) will be allowed, 1 service per arm, using CPTcode 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 StudiesEach descriptor (code) from CPTcodes 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. CPTcode 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.ElectromyographyIt is expected that providers will use CPTcode 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 CPTcode 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.