Local Coverage Determination (LCD)

Somatosensory Testing

L33958

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
First Coast Service Options, Inc.	A and B MAC	09102 - MAC B	J - N	Florida
First Coast Service Options, Inc.	A and B MAC	09202 - MAC B	J - N	Puerto Rico
First Coast Service Options, Inc.	A and B MAC	09302 - MAC B	J - N	Virgin Islands

LCD Information

Document Information

LCD ID
L33958

LCD Title
Somatosensory Testing

Proposed LCD in Comment Period
N/A

Source Proposed LCD
N/A

Original Effective Date
For services performed on or after 10/01/2015

Revision Effective Date
For services performed on or after 01/08/2019

Revision Ending Date
N/A

Retirement Date
N/A

Notice Period Start Date
N/A

Notice Period End Date
N/A

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Somatosensory Testing. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for Somatosensory Testing and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site.

Internet Only Manual (IOM) Citations:

CMS IOM Publication 100-02, Medicare Benefit Policy Manual,

Chapter 15, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests

CMS IOM Publication 100-08, Medicare Program Integrity Manual,

Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD

Social Security Act (Title XVIII) Standard References:

Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.

Federal Register References:

Code of Federal Regulations (CFR), Title 42, Volume 2, Chapter IV, Part 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions and Part 410.33 Independent diagnostic testing facility.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

History/Background and/or General Information

Short-latency somatosensory evoked potentials (SEPs) represent early electrophysiologic responses of the somatosensory pathways to stimulation. Somatosensory testing involves the application of multiple brief electrical stimuli over peripheral nerves (e.g., the median, peroneal, and tibial nerves) and recording the evoked potentials over proximal portions of the nerves stimulated, the plexus, spine and/or scalp. These readings are then averaged by a computer and can be traced and recorded in the form of waveforms. A physician trained in interpreting clinical evoked potential studies then interprets these waveforms. The waveforms obtained should be described and the peak latencies, interpeak intervals (when appropriate), and amplitudes of the significant components detailed. The nerves most commonly stimulated are the median nerve at the wrist for testing in the upper extremity, and the common peroneal nerve (CPN) at the knee and the posterior tibial nerve at the ankle for the lower extremity.

Covered Indications

The use of short-latency somatosensory evoked potentials will be considered to be medically reasonable and necessary to assist in the diagnosis of certain neuropathologic states (as described below) in order to provide information for treatment and for intraoperative testing during spinal surgeries in which there is risk of additional nerve or spinal cord injury.

SEPs are used to evaluate the more proximal segments of nerves and the integrity of the central somatosensory pathways when slowing of conduction through the brain and/or brainstem, spinal cord, and/or peripheral nerves is suspected. This would include conditions such as multiple sclerosis, cervical spondylosis with myelopathy, coma, spinal cord trauma, hereditary and idiopathic peripheral neuropathies, inflammatory and toxic neuropathies, myoclonus, Friedreich’s ataxia, syringomyelia, spinal cord tumors, spinal stenosis and other conditions where there is spinal cord compression.

Limitations

SEP studies are appropriate only when a detailed clinical history and neurologic examination and imaging studies, and EMG/Nerve Conduction studies have failed to provide adequate information for a specific treatment plan.

As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.

Provider Qualifications

SEP studies are covered when performed by providers of neurology services or other providers who have specialized training and expertise in performing and interpreting this test. Such training should include adequate educational experience in the following:

The influences of stimulus parameters and other experimental variables on the responses that are recorded.
Existing knowledge of the anatomic structures and neurophysiologic events underlying the generation of evoked potentials.
The clinical significance and pathologic correlates of dysfunctional neural pathways demonstrated by evoked potentials alterations.
Relevant normative data and statistics.

Training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty. If this skill has been acquired as continuing medical education, the courses must be comprehensive, offered or sponsored or endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States, and designated by the American Medical Association (AMA) as Category 1 Credit.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes

Changes	Fields Changed
	N/A

Associated Information

Sources of Information

Bibliography

Open Meetings

Contractor Advisory Committee (CAC) Meetings

MAC Meeting Information URLs

Proposed LCD Posting Date

Comment Period Start Date

Comment Period End Date

Reason for Proposed LCD

Requestor Name	Requestor Letter
	View Letter

Requestor Information

Contact for Comments on Proposed LCD

Coding Information

ICD-10-CM Codes that Support Medical Necessity

ICD-10-CM Codes that DO NOT Support Medical Necessity

Additional ICD-10 Information

General Information

Associated Information

Documentation Requirements

Please refer to the Local Coverage Article: Billing and Coding: Somatosensory Testing (A57540) for documentation requirements that apply to the reasonable and necessary provisions outlined in this LCD.

Utilization Guidelines

Please refer to the Local Coverage Article: Billing and Coding: Somatosensory Testing (A57540) for utilization guidelines that apply to the reasonable and necessary provisions outlined in this LCD.

Sources of Information

First Coast Service Options, Inc. reference LCD number – L29394

American Association of Electrodiagnostic Medicine (AAEM). (2006).
Recommended policy for electrodiagnostic medicine. Retrieved December 5, 2006

American Association of Neuromuscular & Electrodiagnostic Medicine. (2006). Proper performance and interpretation of electrodiagnostic studies. Muscle Nerve 33:436-439.

Goetz, C.G. (2003). Textbook of Clinical Neurology, 2nd ed. Chicago: Saunders.
Legatt, A. (2006). Somatosensory Evoked Potentials: General Principles.

Bibliography

N/A

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation	Reasons for Change
01/08/2019	R4	Revision Number: 3 Publication: October 2019 Connection LCR B2019-030 Explanation of Revision: Based on Change Request (CR) 10901, the LCD was revised to remove all billing and coding and all language not related to reasonable and necessary provisions (“Bill Type Codes,” “Revenue Codes,” “CPT/HCPCS Codes,” “ICD-10 Codes that Support Medical Necessity,” “Documentation Requirements” and “Utilization Guidelines” sections of the LCD) and place them into a newly created billing and coding article. During the process of moving the ICD-10-CM diagnosis codes to the billing and coding article, the ICD-10-CM diagnosis code ranges were broken out and listed individually. In addition, the Social Security Act, Code of Federal Regulations, and IOM reference sections were updated. The effective date of this revision is for claims processed on or after January 8, 2019, for dates of service on or after October 3, 2018. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this LCD.	Other (Revision based on CR 10901)
10/01/2017	R3	Revision Number: 2 Publication: September 2017 Connection LCR B2017-011 Explanation of Revision: Based on CR 10153 (Annual 2018 ICD-10-CM Update) the LCD was revised. Changed ICD-10-CM diagnosis code range M48.06-M48.07 to M48.061-M48.07. Deleted ICD-10-CM diagnosis code M48.06. The effective date of this revision is based on date of service. 10/01/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this policy.	Revisions Due To ICD-10-CM Code Changes
10/01/2016	R2	Based on CR 9677 (Annual 2017 ICD-10-CM Update), the LCD was revised; he following ICD-10 codes were added to these code ranges in the ICD-10 Codes that Support Medical Necessity field: G61.82 was added to code range G61.0 - G65.2 in Group 1	Revisions Due To ICD-10-CM Code Changes
10/01/2015	R1	Revision Number: 1 Publication: December 2015 Connection LCR B2015-084 Explanation of revision: This LCD was revised to include ICD-10 code range M48.06-M48.07 in the “ICD-10 Codes that Support Medical Necessity” section of the LCD. The effective date of this revision is for claims processed on or after 12/02/2015, for dates of service on or after 10/01/15.	Revisions Due To ICD-10-CM Code Changes

Associated Documents

Attachments
N/A

Related Local Coverage Documents
Articles
A57540 - Billing and Coding: Somatosensory Testing
A57535 - Somatosensory testing revision to the Part B LCD (MCD Archive Site)

Updated On	Effective Dates	Status
10/16/2019	01/08/2019 - N/A	Currently in Effect	You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A

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Somatosensory Testing

Document Note

Note History

Contractor Information

LCD Information

Document Information

Issue

CMS National Coverage Policy

Coverage Guidance

Proposed Process Information

Coding Information

Bill Type Codes

Revenue Codes

CPT/HCPCS Codes

Group 1

ICD-10-CM Codes that Support Medical Necessity

Group 1

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Additional ICD-10 Information

General Information

Revision History Information

Associated Documents

Keywords

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