This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35081 Nerve Conduction Studies and Electromyography. Please refer to the LCD for reasonable and necessary requirements.
Coding Guidance
Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.
Electromyography (EMG)
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. The contractor would not expect to see this code billed when the paraspinal muscles corresponding to an extremity are tested and when the extremity EMG codes 95860, 95861, 95863 or 95864 are also billed.
Surface and macro EMG should be reported with CPT code 95999. This service is not the same as a conventional EMG and involves the use of a probe that is passed over the surface of the skin in order to measure electrical muscle activity. Please refer to the related LCD for additional information on surface and macro EMG.
Nerve Conduction Studies (NCS)
Nerve conduction studies performed using automated devices (for example devices such as NC-stat® System) should be billed with CPT code 95905. These studies should not be billed with any other CPT code. CPT code 95905 cannot be billed in conjunction with any other nerve conduction codes.
CPT code 95905 can only be reported once per upper extremity limb per patient per year when reported with one of the following diagnosis codes: G56.00, G56.01, G56.02, or G56.03.
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 7a).; 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 7a 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.
”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 & PC), or by a technician with certification under general supervision of a physician (TC only; PC always physician).”
Diagnostic or Therapeutic Services performed by a CORF
Diagnostic or therapeutic services provided to a CORF patient by the CORF physician or other physician are not CORF physician services. Such services are separately payable to the physician and not the CORF under the physician fee schedule at the non-facility payment amount. These services should be billed as if they were provided in the physician’s office. (See 42CFR410.100[a]).
Since the diagnostic Nerve Conduction studies are outside of the CORF administrative services, they should be billed to Part B.
Note: Nerve Conduction Studies and EMGs performed on the same day, to the same beneficiary should be reported on the same claim.
Documentation Requirements
- All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.