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National Coverage Determination (NCD)

Sensory Nerve Conduction Threshold Tests (sNCTs)

160.23

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Tracking Information

Publication Number
100-3
Manual Section Number
160.23
Manual Section Title
Sensory Nerve Conduction Threshold Tests (sNCTs)
Version Number
2
Effective Date of this Version
04/01/2004
Ending Effective Date of this Version
Implementation Date
04/01/2004
Implementation QR Modifier Date

Description Information

Benefit Category
Diagnostic X-Ray Tests


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

A. General

The sNCT is a psychophysical assessment of both central and peripheral nerve functions. It measures the detection threshold of accurately calibrated sensory stimuli. This procedure is intended to evaluate and quantify function in both large and small caliber fibers for the purpose of detecting neurologic disease. Sensory perception and threshold detection are dependent on the integrity of both the peripheral sensory apparatus and peripheral-central sensory pathways. In theory, an abnormality detected by this procedure may signal dysfunction anywhere in the sensory pathway from the receptors, the sensory tracts, the primary sensory cortex, to the association cortex.

This procedure is different and distinct from assessment of nerve conduction velocity, amplitude and latency. It is also different from short-latency somatosensory evoked potentials.

Effective October 1, 2002, CMS initially concluded that there was insufficient scientific or clinical evidence to consider the sNCT test and the device used in performing this test reasonable and necessary within the meaning of section 1862(a)(1)(A) of the law. Therefore, sNCT was noncovered.

Effective April 1, 2004, based on a reconsideration of current Medicare policy for sNCT, CMS concludes that the use of any type of sNCT device (e.g., “current output” type device used to perform current perception threshold (CPT), pain perception threshold (PPT), or pain tolerance threshold (PTT) testing or “voltage input” type device used for voltage-nerve conduction threshold (v-NCT) testing) to diagnose sensory neuropathies or radiculopathies in Medicare beneficiaries is not reasonable and necessary.
Indications and Limitations of Coverage

B. Nationally Covered Indications

Not applicable.

C. Nationally Noncovered Indications

All uses of sNCT to diagnose sensory neuropathies or radiculopathies are noncovered.

(This NCD last reviewed June 2004.)
Cross Reference
Claims Processing Instructions

Transmittal Information

Transmittal Number
15
Coverage Transmittal Link
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R15NCD.pdf
Revision History

06/2004 - Reaffirmed existing Medicare noncoverage policy on any type of Sensory Nerve Conduction Threshold (sNCT) Test, and device used to perform test, to diagnose sensory neuropathies or radiculopathies. Recinds and replaces TN 8. Effective and implementation dates 04/01/2004. (TN 15) (CR 3339)

03/2004 - Reaffired existing Medicare noncoverage policy on Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT). Effective and implementation dates 04/01/2004. (TN 8) (CR 2988)

05/2002 - Provided that there is insufficient scientific or clinical evidence to consider this device as reasonable and necessary within the meaning of §1862(a)(1)(A) of the Social Security Act and will not be covered by Medicare. Also, established a new code G0255 for this test. The code descriptor is Current Perception Threshold/Sensory Nerve Conduction Threshold test (sNCT), per limb, any nerve - (Not covered by Medicare). Effective and implementation dates 07/01/2002. (TN 156) (CR 2153)
Other

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Coding Analyses for Labs (CALs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.

Additional Information

Other Versions
Title Version Effective Between
Sensory Nerve Conduction Threshold Tests (sNCTs) 2 04/01/2004 - N/A You are here
Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT) NonCovered 1 10/01/2002 - 04/01/2004 View
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CPT only copyright 2002-2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
Reasons for Denial
Note: This section has not been negotiated by the Negotiated RuleMaking Committee. It includes CMS’s interpretation of it’s longstanding policies and is included for informational purposes. Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease or injury are not covered except as explicity authorized by statue. These include exams required by insurance companies, business establishments, government agencies, or other third parties. Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue. Failure to provide documentation of the medical necessity of tests may result in denial of claims. The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests. In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner) through documentation in the physician’s office may result in denial. A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessary if it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentation justifying the necessity is submitted with the claim. If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied as not reasonable and necessary, unless it is submitted with documentation justifying increased frequency. Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope of their license and in compliance with Medicare requirements will be denied as not reasonable and necessary. Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificate for the testing performed will result in denial of claims.
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