Description
Medical documentation will be reviewed to determine if the use of nerve conduction studies meets Medicare coverage criteria and is reasonable and necessary.
Affected Code(s)
95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913
Applicable Policy References
1. SSA, Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2. SSA, Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
3. 42 Code of Federal Regulations (CFR) §410.32- Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.
4. 42 CFR §405.929- Post-Payment Review
5. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
6. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
7. 42 Code of Federal Regulations (CFR) §405.986- Good Cause for Reopening
8. Medicare National Coverage Determination Manual, Chapter 1, Part 2, §160.23- Sensory Nerve Conduction Threshold Tests (sNCTs)
9. Medicare Benefit Policy Manual, Chapter 15- Covered Medical and Other Health Services, §80- Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
10. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
11. CGS, Local Coverage Determination L35897- Nerve Conduction Studies and Electromyography; Effective: 10/01/2015; Revised 04/27/2023
12. First Coast Local Coverage Determination L34859- Nerve Conduction Studies and Electromyography; Effective: 10/01/2015; Revised 10/01/2019
13. NGS, Local Coverage Determination L35098- Nerve Conduction Studies and Electromyography; Effective: 10/01/2015; Revised 11/21/2019
14. Noridian Healthcare Solutions, LLC, Local Coverage Determination L36524- Nerve Conduction Studies and Electromyography; Effective: 06/01/16; Revised 12/01/2019
15. Noridian Healthcare Solutions, LLC, Local Coverage Determination L36526- Nerve Conduction Studies and Electromyography; Effective: 06/01/2016; Revised 12/01/2019
16. Novitas Solutions, Inc., Local Coverage Determination L35081- Nerve Conduction Studies and Electromyography; Effective: 10/01/2015; Revised 10/31/2019
17. Palmetto GBA Local Coverage Determination L35048- Nerve Conduction Studies and Electromyography; Effective: 10/01/2015; Revised 07/15/2021
18. WPS Local Coverage Determination L34594- Nerve Conduction Studies and Electromyography; Effective: 10/01/2015; Revised 06/01/2023
19. CGS, Local Coverage Article A57307- Billing and Coding: Nerve Conduction Studies and Electromyography; Effective: 9/26/2019; Revised 04/27/2023
20. First Coast Local Coverage Article A57123- Billing and Coding: Nerve Conduction Studies and Electromyography; Effective: 10/03/2018; Revised 01/01/2023
21. First Coast Local Coverage Article A56035- Nerve Conduction Studies and Electromyography- Revision to the Part A and Part B LCD; Effective: 5/31/2018, Retired 09/24/2021
22. NGS, Local Coverage Article A57668- Billing and Coding: Nerve Conduction Studies and Electromyography; Effective: 11/21/2019; Revised 10/01/2022
23. Noridian Healthcare Solutions, LLC, Local Coverage Article A54969- Billing and Coding: Nerve Conduction Studies and Electromyography; Effective: 6/01/2016; Revised 10/01/2022
24. Noridian Healthcare Solutions, LLC, Local Coverage Article A54992- Billing and Coding: Nerve Conduction Studies and Electromyography; Effective: 6/01/2016; Revised 10/01/2022
25. Novitas Solutions, Inc., Local Coverage Article A54095- Billing and Coding: Nerve Conduction Studies and Electromyography; Effective: 10/01/2015; Revised 01/01/2023
26. Palmetto GBA Local Coverage Article A56619- Billing and Coding: Nerve Conduction Studies and Electromyography; Effective: 6/13/2019; Revised 01/01/2023
27. WPS Local Coverage Article A57478- Billing and Coding: Nerve Conduction Studies and Electromyography; Effective: 10/31/2019; Revised 06/01/2023
28. AMA CPT Manual