Please note: This version is not currently in effect.
Please note: If you are printing this document and it is truncated on the right margin, please try printing landscape.
| LCD Information |
|
|
| LCD ID Number back to top |
| L24053 |
| |
| LCD Title back to top |
| Electrodiagnostic Testing: Nerve conduction studies (NCS) & Electromyography (EMG) |
| |
| Contractor's Determination Number back to top |
| 2007-001 |
| |
| AMA CPT / ADA CDT Copyright Statement back to top |
|
CPT codes, descriptions and other data only are copyright
2009 American Medical Association (or such other date of publication of CPT).
All Rights Reserved. Applicable FARS/DFARS Clauses Apply.
Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
|
| |
| CMS National Coverage Policy back to top |
-Medicare Benefit Policy Manual - Pub. 100-2
-Medicare National Coverage Determinations Manual - Pub. 100-3, Ch. 1, sect 160.23, NCD for Sensory Nerve Conduction Threshold
-Correct Coding Initiative - Medicare Contractor Beneficiary and Provider Communications Manual - Pub. 100-9, Chapter 5
Social Security Act (Title XVIII) Standard References
-Section 1862 (a)(1)(A) Medically Reasonable & Necessary
-Section 1862 (a)(1)(D) Investigational or Experimental
-Section 1862 (a)(7) Screening (Routine Physical Checkups)
-Section 1833(e) Requirement for sufficient documentation
|
| |
| Primary Geographic Jurisdiction back to top |
North Carolina
|
| |
| Oversight Region back to top |
| Region IV |
| |
| |
| Original Determination Effective Date back to top |
|
For services performed on or after
02/04/2007
|
| |
| Original Determination Ending Date back to top |
| |
| |
| Revision Effective Date back to top |
|
For services performed on or after
02/04/2007
|
| |
| Revision Ending Date back to top |
| |
| |
| Indications and Limitations of Coverage and/or Medical Necessity back to top |
PLEASE NOTE REFERENCE ARTICLE UNDER RELATED DOCUMENTS.
Introductory Note: CIGNA Government Services expects healthcare professionals who perform electrodiagnostic (ED) testing will be appropriately trained and/or credentialed, either by a formal residency/fellowship program and certification by a nationally recognized organization, or by an accredited post-graduate training course covering anatomy, neurophysiology and forms of electrodiagnostics [including both NCT and EMG]acceptable to this Carrier, in order to provide the proper testing and assessment of the patient's condition, and appropriate safety measures. In North Carolina, appropriately qualified Physical Therapists can perform and make physical therapy interpretation, but not medical diagnosis based on the results. Also, supervision as described in Medicare Manuals must be appropriate, as follows: for CPT codes 95860, 95861, 95863, 95864, 95867, 95868, 95869, and 95870, level 6a is required, which means the service must be performed personally by the physician or specially qualified Physical Therapist (and who is permitted to perform the test under state law); for CPT codes 95900, 95903, 95904, 95933, 95934,and 95937 require level 7 supervision, which means the service must be personally performed by a qualified physician or qualified Physical Therapist or performed under the direct supervision of a physician or technician with certification. CPT 95872 requires level 66 supervision, which means the service may be performed by a physician or ABPTS certified Physical Therapist. Individuals not meeting these criteria who perform electrodiagnostic testing may be asked for credentials indicating proficiency, or have claims subject to review and denial as not medically necessary.
Appropriate neuroelectrodiagnosis frequently requires both NCS and EMG. Performance of one may not eliminate the need for the other. The intensity and extent of testing with EMG and/or NCT are matters of clinical judgment developed after the initial pre-test evaluation, and later modified as required during the testing procedure. The decision(s) to continue, modify or conclude testing also are matters of judgment, and are based in knowledge of anatomy, physiology and neuromuscular diseases. There must be on-going real time clinical evaluation during the testing process. The electrodiagnostic evaluation is an extension of the neurological portion of the physical examination. Both require a detailed knowledge of the patient and the disease. Training in the performance of ED procedures in isolation without awareness of and ability to diagnose and manage neuromuscular diseases is not generally adequate for ED consultation and testing. This is a major reason for requiring appropriate training and/or certification of those performing such testing.
NERVE CONDUCTION Testing (NCT)
NCTs measure action potentials recorded over the nerve or from an innervated muscle. Nerve Conduction Velocity (NCV), one aspect of NCT, is measured between two sites of stimulation or between a stimulus and a recording site. It is axiomatic that neurodiagnostic studies are an extension of the history and physical examination of the patient, and must be performed as part of a face- to-face encounter. Obtaining and interpreting nerve conduction velocities requires extensive interaction between the performing physician and patient and is most effective when both obtaining raw data and interpretation are performed together on a real-time basis by a single physician.
Results of NCV reflect on the integrity and function of: 1) the myelin sheath (Schwann cell derived insulation covering an axon); and, 2) the axon (an extension of the neuronal cell body) of a nerve. Axonal damage or dysfunction generally results in loss of nerve or muscle potential amplitude, whereas demyelination leads to prolongation of conduction time.
The following are examples of appropriate clinical settings where nerve conduction studies are helpful in diagnosis:
- Focal neuropathies or compressive lesions such as carpal tunnel syndrome, ulnar neuropathies, or root lesions for localization.
- Traumatic nerve lesions for diagnosis and prognosis.
- Diagnosis or confirmation of suspected generalized neuropathies, such as diabetic, uremic, metabolic, inflammatory, or immune.
- Repetitive nerve stimulation in diagnosis of neuromuscular junction disorders such as myasthenia gravis and myasthenic syndromes.
The number of sites tested per study depends upon the conditions being evaluated. Generally, the following diagnoses may be established without exceeding the unit limits, which follow:
(General template for use with listings below:)
Conditions (ICD-9 code)
Motor NCV 95900 - number of studies
Sensory NCV 95904 - number of studies
F-Wave Study(ies) 95903 - number of studies
H-reflex Study(ies) 95934 & 95936 - number of studies
Carpal tunnel - Unilateral (354.0)
3
4
Documentation of medical necessity required
Documentation of medical necessity required
Carpal tunnel - Bilateral (354.0)
4
6
Documentation of medical necessity required
Documentation of medical necessity required
Hemiplegia (342.00-342.02 342.10-342.12 342.80-342.82 342.90-342.92)
Rarely requires electro-diagnostic testing
Rarely requires electro-diagnostic testing
Rarely requires electro-diagnostic testing
Rarely requires electro-diagnostic testing
Radiculopathy, (i e., sciatica - 724.00-724.02, 724.1, 724.3-724.4)
3
2
2
2
Mono/poly-neuropathy (356.0-356.4, 356.8-356.9, 357.0-357.7, 357.81-357.82, 357.89, 357.9)
4
4
2
2
Myopathy (359.81, 359.89, 359.9)
2
2
Late wave studies usually not indicated
ALS (335.20-335.24)
4
4
Late wave studies usually not indicated
Plexopathy (353.0-353.6, 353.8-353.9)
4 - 6
4 - 6
One study per extremity tested
Neuromuscular junction disorder (358.00-358.01, 358.1-358.2, 358.8-358.9)
2
2
Documentation of medical necessity required
Documentation of medical necessity required
F-wave studies are often performed in conjunction with motor NCS; H-reflex studies involve both sensory and motor nerves and their connections with the spinal cord. The device used must be capable of recording amplitude, duration, response configuration (motor NCV) and latency and sensory nerve action potential amplitudes (sensory NCV). Sensory perception or other testing by simple hand-held devices (Neurometer and current perception testing with any method) should not be billed as NCT.
Quantitative sensory testing (QST) and sensory nerve conduction threshold (s-NCT) are different from NCT, and are not considered payable as NCT. Both are psychophysical tests that are dependent on subjective interpretation of sensation by the patient. These are considered similar to visual acuity testing or use of a tuning fork or the Semmes-Weinstein monofilament, and as such, are considered included in the physical evaluation, and not separately payable. These tests, when rendered by whatever method or commercially available device, should not be billed to Medicare with CPT codes 95900, 95903 or 95904.
Initial nerve conduction testing of a symptomatic patient with possible neuropathy may be performed as an adjunct to the physical examination with devices that use fixed anatomic templates and computer-generated reports (such as the NC-Stat device), and use of such devices may be covered in some clinically appropriate circumstances when not performed as a screening test. Such testing should not be billed with CPT codes 95900, 95903 and 95904. Documentation should include the name of the particular device used. (Please see accompanying article for billing instructions.)
Electromyography (EMG)
Electromyography (EMG) is the study of intrinsic electrical properties of skeletal muscle utilizing insertion of a (frequently disposable) needle electrode into muscles of interest. EMG is usually performed in conjunction with NCS; however, EMG testing relies on both auditory and visual feedback from the electromyographer. EMG results reflect not only the integrity of the functioning connection between a nerve and its innervated muscle, but on the integrity of the muscle itself. The device used must be capable of recording motor unit recruitment, amplitude, configuration, spontaneous, and insertional activity. Both EMGs and NCVs are often required for a clinical diagnosis of peripheral nervous system disorders. Use for intraoperative monitoring of central nervous system tissue during the resection of benign and malignant neoplasia, and during corrective surgery for scoliosis may also be needed.
The axon innervating a muscle is primarily responsible for the muscles volitional contraction, survival, and trophic functions. Prime examples of diseases characterized by abnormal EMG are disc disease with abnormal nerve compression, amyotrophic lateral sclerosis, and neuropathies. Axonal and muscle involvement are most sensitively detected by EMGs, and myelin and axonal involvement are best detected by NCV.
Use of EMG with Botulinum Toxin Injection
EMG may be used to optimize the anatomic location of botulinum toxin injection. It is expected there will be one study performed per anatomic location of injection, if needed. The dosage and wastage of toxin must be documented. It is expected that the accompanying study to the injection be billed as a limited study (95874) unless supportive accompanying documentation is submitted to show why more extensive studies are indicated.
Limitations
1. Testing by simple hand-held devices or pressure-sensitive sensory devices is not covered by Medicare. Nerve conduction studies must provide, in a real-time fashion to facilitate provider interpretation, a number of response parameters. Those parameters include amplitude, latency, configuration and sensory conduction velocity. Medicare does not accept diagnostic studies that do not provide this information or those that provide delayed interpretation as substitutes for nerve conduction studies. Raw measurement data obtained and transmitted trans-telephonically or over the Internet, therefore, does not qualify for the payment of the electrodiagnostic service codes included in this policy.
2. Each descriptor (code) can be reimbursed only once per nerve regardless of the number of sites tested or the number of methods used. For instance, testing the ulnar nerve at wrist, forearm, below elbow, above elbow, axilla and supraclavicular regions will all be considered as a single unit test of code 95900 or 95904. For orthodromic and antidromic testing, only one unit of charge will be paid.
3. Screening testing for polyneuropathy of diabetes or endstage renal disease (ESRD) is NOT covered. Testing for the sole purpose of monitoring disease intensity or treatment efficacy in these two conditions is also not covered.
4. Psychophysical measurements (current, vibration, thermal perceptions), even though they may involve delivery of a stimulus, are not covered.
5. Certain less than optimal practices are discouraged, and may invite reviews. They are: narrative reports alluding to "normal" or "abnormal" results without numerical data, descriptions of F-wave without reference to a corresponding motor conduction data; pattern-setting unilateral H-reflex measurements.
6. The necessity and reasonableness of the following uses of EMG studies have not been established:
a) exclusive testing of intrinsic foot muscles in the diagnosis of proximal lesions
b) definitive diagnostic conclusions based on paraspinal EMG in regions bearing scar of past surgeries (e.g., previous laminectomies)
c) pattern-setting limited limb muscle examinations, without paraspinal muscle testing for a diagnosis of radiculopathies
d) premature EMG testing after trauma when EMG changes may not have taken place.
7. Electromyographic studies that are performed with surface electrodes instead of needle technology, and nerve conduction studies that do not provide real-time conduction, amplitude and latency/velocity data are not to be billed with the standard electrodiagnostic codes (i.e., code 95860 for EMG or 95900 for nerve conduction studies). Such studies may be denied as not medically necessary.
8. Each ED test must have a separate specific report to be a payable service. A report cannot be part of an office note. Electronic automatically generated reports by the machine or device are not acceptable as work done by the physician. There must be a separate identifiable report by the physician containing all the required elements to be a payable service.
Note: Nerve conduction studies and EMG will not be covered if provided in the beneficiary's home.
Note: Intra-operative Neurophysiological monitoring, CPT code 95920, has been removed from this LCD, and is now treated separately in North Carolina LCD L24058.
|
| |
|
| Coding Information |
|
|
Bill Type Codes: back to top
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. |
|
|
| |
Revenue Codes: back to top
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. |
|
| |
| CPT/HCPCS Codes back to top |
Nerve Conduction Studies (NCS)
| 95900 |
Motor nerve conduction test |
| 95903 |
Motor nerve conduction test |
| 95904 |
Sense nerve conduction test |
| 95933 |
Blink reflex test |
| 95934 |
H-reflex test |
| 95936 |
H-reflex test |
| 95937 |
Neuromuscular junction test |
|
Electromyography (EMG)
| 95860 |
Muscle test, one limb |
| 95861 |
Muscle test, 2 limbs |
| 95863 |
Muscle test, 3 limbs |
| 95864 |
Muscle test, 4 limbs |
| 95865 |
Muscle test, larynx |
| 95866 |
Muscle test, hemidiaphragm |
| 95867 |
Muscle test cran nerv unilat |
| 95868 |
Muscle test cran nerve bilat |
| 95869 |
Muscle test, thor paraspinal |
| 95870 |
Muscle test, nonparaspinal |
| 95872 |
Muscle test, one fiber |
| 95873 |
Guide nerv destr, elec stim |
| 95874 |
Guide nerv destr, needle emg |
|
|
| |
| ICD-9 Codes that Support Medical Necessity back to top |
The CPT/HCPCS codes included in this policy will be subjected to "procedure to diagnosis" editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as "not medically necessary."
Medicare is establishing the following limited coverage for CPT/HCPCS codes 95865 and 95866:
| 784.49 |
OTHER VOICE DISTURBANCE |
|
Medicare is establishing the following limited coverage for CPT/HCPCS codes 95867 and 95868:
Covered for:
| 037 |
TETANUS |
| 191.7 |
MALIGNANT NEOPLASM OF BRAIN STEM |
|
192.1 - 192.2
|
MALIGNANT NEOPLASM OF CEREBRAL MENINGES - MALIGNANT NEOPLASM OF SPINAL CORD |
|
198.3 - 198.4
|
SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD - SECONDARY MALIGNANT NEOPLASM OF OTHER PARTS OF NERVOUS SYSTEM |
|
250.60 - 250.63
|
DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED |
|
350.1 - 350.2
|
TRIGEMINAL NEURALGIA - ATYPICAL FACE PAIN |
|
350.8 - 350.9
|
OTHER SPECIFIED TRIGEMINAL NERVE DISORDERS - TRIGEMINAL NERVE DISORDER UNSPECIFIED |
|
351.0 - 351.1
|
BELL'S PALSY - GENICULATE GANGLIONITIS |
|
351.8 - 351.9
|
OTHER FACIAL NERVE DISORDERS - FACIAL NERVE DISORDER UNSPECIFIED |
|
352.0 - 352.6
|
DISORDERS OF OLFACTORY (1ST) NERVE - MULTIPLE CRANIAL NERVE PALSIES |
| 352.9 |
UNSPECIFIED DISORDER OF CRANIAL NERVES |
| 357.0 |
ACUTE INFECTIVE POLYNEURITIS |
|
358.00 - 358.01
|
MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION - MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION |
|
Medicare is establishing the following limited coverage for CPT/HCPCS codes 95860, 95861, 95863, 95864, 95866, 95869, 95900 and 95937 (non-cranial EMG and NCS):
Covered for:
| 037 |
TETANUS |
| 170.2 |
MALIGNANT NEOPLASM OF VERTEBRAL COLUMN EXCLUDING SACRUM AND COCCYX |
| 170.6 |
MALIGNANT NEOPLASM OF PELVIC BONES SACRUM AND COCCYX |
| 191.7 |
MALIGNANT NEOPLASM OF BRAIN STEM |
|
192.2 - 192.3
|
MALIGNANT NEOPLASM OF SPINAL CORD - MALIGNANT NEOPLASM OF SPINAL MENINGES |
|
198.3 - 198.5
|
SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD - SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW |
| 213.2 |
BENIGN NEOPLASM OF VERTEBRAL COLUMN EXCLUDING SACRUM AND COCCYX |
| 213.6 |
BENIGN NEOPLASM OF PELVIC BONES SACRUM AND COCCYX |
| 225.3 |
BENIGN NEOPLASM OF SPINAL CORD |
|
250.60 - 250.63
|
DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED |
| 265.1 |
OTHER AND UNSPECIFIED MANIFESTATIONS OF THIAMINE DEFICIENCY |
| 269.1 |
DEFICIENCY OF OTHER VITAMINS |
| 335.0 |
WERDNIG-HOFFMANN DISEASE |
|
335.10 - 335.11
|
SPINAL MUSCULAR ATROPHY UNSPECIFIED - KUGELBERG-WELANDER DISEASE |
| 335.19 |
OTHER SPINAL MUSCULAR ATROPHY |
|
335.20 - 335.24
|
AMYOTROPHIC LATERAL SCLEROSIS - PRIMARY LATERAL SCLEROSIS |
| 335.29 |
OTHER MOTOR NEURON DISEASES |
|
335.8 - 335.9
|
OTHER ANTERIOR HORN CELL DISEASES - ANTERIOR HORN CELL DISEASE UNSPECIFIED |
|
336.0 - 336.3
|
SYRINGOMYELIA AND SYRINGOBULBIA - MYELOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE |
|
336.8 - 336.9
|
OTHER MYELOPATHY - UNSPECIFIED DISEASE OF SPINAL CORD |
|
337.0 - 337.1
|
IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY - PERIPHERAL AUTONOMIC NEUROPATHY IN DISORDERS CLASSIFIED ELSEWHERE |
|
337.20 - 337.22
|
REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED - REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB |
| 337.29 |
REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE |
| 337.3 |
AUTONOMIC DYSREFLEXIA |
| 337.9 |
UNSPECIFIED DISORDER OF AUTONOMIC NERVOUS SYSTEM |
| 340 |
MULTIPLE SCLEROSIS |
|
341.0 - 341.1
|
NEUROMYELITIS OPTICA - SCHILDER'S DISEASE |
|
341.8 - 341.9
|
OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM - DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM UNSPECIFIED |
|
342.00 - 342.02
|
FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE |
|
342.10 - 342.12
|
SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE |
|
342.80 - 342.82
|
OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE |
|
342.90 - 342.92
|
UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE |
|
343.0 - 343.4
|
CONGENITAL DIPLEGIA - INFANTILE HEMIPLEGIA |
|
343.8 - 343.9
|
OTHER SPECIFIED INFANTILE CEREBRAL PALSY - INFANTILE CEREBRAL PALSY UNSPECIFIED |
|
344.00 - 344.04
|
QUADRIPLEGIA UNSPECIFIED - QUADRIPLEGIA C5-C7 INCOMPLETE |
| 344.09 |
OTHER QUADRIPLEGIA |
|
344.1 - 344.2
|
PARAPLEGIA - DIPLEGIA OF UPPER LIMBS |
|
344.30 - 344.32
|
MONOPLEGIA OF LOWER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE |
|
344.40 - 344.42
|
MONOPLEGIA OF UPPER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SDE |
| 344.5 |
UNSPECIFIED MONOPLEGIA |
|
344.60 - 344.61
|
CAUDA EQUINA SYNDROME WITHOUT NEUROGENIC BLADDER - CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER |
| 344.81 |
LOCKED-IN STATE |
| 344.89 |
OTHER SPECIFIED PARALYTIC SYNDROME |
| 344.9 |
PARALYSIS UNSPECIFIED |
|
353.0 - 353.6
|
BRACHIAL PLEXUS LESIONS - PHANTOM LIMB (SYNDROME) |
|
353.8 - 353.9
|
OTHER NERVE ROOT AND PLEXUS DISORDERS - UNSPECIFIED NERVE ROOT AND PLEXUS DISORDER |
|
354.0 - 354.5
|
CARPAL TUNNEL SYNDROME - MONONEURITIS MULTIPLEX |
|
354.8 - 354.9
|
OTHER MONONEURITIS OF UPPER LIMB - MONONEURITIS OF UPPER LIMB UNSPECIFIED |
|
355.0 - 355.6
|
LESION OF SCIATIC NERVE - LESION OF PLANTAR NERVE |
| 355.71 |
CAUSALGIA OF LOWER LIMB |
| 355.79 |
OTHER MONONEURITIS OF LOWER LIMB |
|
355.8 - 355.9
|
MONONEURITIS OF LOWER LIMB UNSPECIFIED - MONONEURITIS OF UNSPECIFIED SITE |
|
356.0 - 356.4
|
HEREDITARY PERIPHERAL NEUROPATHY - IDIOPATHIC PROGRESSIVE POLYNEUROPATHY |
|
356.8 - 356.9
|
OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY - UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY |
|
357.0 - 357.7
|
ACUTE INFECTIVE POLYNEURITIS - POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS |
|
357.81 - 357.82
|
CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS - CRITICAL ILLNESS POLYNEUROPATHY |
| 357.89 |
OTHER INFLAMMATORY AND TOXIC NEUROPATHY |
|
358.00 - 358.01
|
MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION - MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION |
|
358.1 - 358.2
|
MYASTHENIC SYNDROMES IN DISEASES CLASSIFIED ELSEWHERE - TOXIC MYONEURAL DISORDERS |
|
358.8 - 358.9
|
OTHER SPECIFIED MYONEURAL DISORDERS - MYONEURAL DISORDERS UNSPECIFIED |
|
359.0 - 359.6
|
CONGENITAL HEREDITARY MUSCULAR DYSTROPHY - SYMPTOMATIC INFLAMMATORY MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE |
| 359.81 |
CRITICAL ILLNESS MYOPATHY |
| 359.89 |
OTHER MYOPATHIES |
| 359.9 |
MYOPATHY UNSPECIFIED |
| 438.32 |
MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SIDE |
|
438.41 - 438.42
|
MONOPLEGIA OF LOWER LIMB AFFECTING DOMINANT SIDE - MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE |
|
710.3 - 710.5
|
DERMATOMYOSITIS - EOSINOPHILIA MYALGIA SYNDROME |
|
721.1 - 721.3
|
CERVICAL SPONDYLOSIS WITH MYELOPATHY - LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY |
|
721.41 - 721.42
|
SPONDYLOSIS WITH MYELOPATHY THORACIC REGION - SPONDYLOSIS WITH MYELOPATHY LUMBAR REGION |
| 721.91 |
SPONDYLOSIS OF UNSPECIFIED SITE WITH MYELOPATHY |
| 722.0 |
DISPLACEMENT OF CERVICAL INTERVERTEBRAL DISC WITHOUT MYELOPATHY |
|
722.10 - 722.11
|
DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT MYELOPATHY - DISPLACEMENT OF THORACIC INTERVERTEBRAL DISC WITHOUT MYELOPATHY |
| 722.2 |
DISPLACEMENT OF INTERVERTEBRAL DISC SITE UNSPECIFIED WITHOUT MYELOPATHY |
|
722.70 - 722.73
|
INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY UNSPECIFIED REGION - INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY LUMBAR REGION |
|
722.80 - 722.83
|
POSTLAMINECTOMY SYNDROME OF UNSPECIFIED REGION - POSTLAMINECTOMY SYNDROME OF LUMBAR REGION |
|
723.0 - 723.5
|
SPINAL STENOSIS IN CERVICAL REGION - TORTICOLLIS UNSPECIFIED |
|
724.00 - 724.02
|
SPINAL STENOSIS OF UNSPECIFIED REGION - SPINAL STENOSIS OF LUMBAR REGION |
| 724.09 |
SPINAL STENOSIS OF OTHER REGION |
| 724.1 |
PAIN IN THORACIC SPINE |
|
724.3 - 724.4
|
SCIATICA - THORACIC OR LUMBOSACRAL NEURITIS OR RADICULITIS UNSPECIFIED |
| 728.0 |
INFECTIVE MYOSITIS |
| 728.88 |
RHABDOMYOLYSIS |
| 729.5 |
PAIN IN LIMB |
|
736.05 - 736.06
|
WRIST DROP (ACQUIRED) - CLAW HAND (ACQUIRED) |
| 737.30 |
SCOLIOSIS (AND KYPHOSCOLIOSIS) IDIOPATHIC |
| 781.0 |
ABNORMAL INVOLUNTARY MOVEMENTS |
|
781.2 - 781.3
|
ABNORMALITY OF GAIT - LACK OF COORDINATION |
| 781.6 |
MENINGISMUS |
| 782.0 |
DISTURBANCE OF SKIN SENSATION |
| 784.49 |
OTHER VOICE DISTURBANCE |
|
788.1 - 788.63
|
DYSURIA - URGENCY OF URINATION |
| 951.4 |
INJURY TO FACIAL NERVE |
|
951.6 - 951.7
|
INJURY TO ACCESSORY NERVE - INJURY TO HYPOGLOSSAL NERVE |
|
952.00 - 952.09
|
C1-C4 LEVEL SPINAL CORD INJURY UNSPECIFIED - C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY |
|
952.10 - 952.19
|
T1-T6 LEVEL SPINAL CORD INJURY UNSPECIFIED - T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY |
|
952.2 - 952.4
|
LUMBAR SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY - CAUDA EQUINA SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY |
|
952.8 - 952.9
|
MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY - UNSPECIFIED SITE OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY |
|
953.0 - 953.5
|
INJURY TO CERVICAL NERVE ROOT - INJURY TO LUMBOSACRAL PLEXUS |
|
953.8 - 953.9
|
INJURY TO MULTIPLE SITES OF NERVE ROOTS AND SPINAL PLEXUS - INJURY TO UNSPECIFIED SITE OF NERVE ROOTS AND SPINAL PLEXUS |
|
954.0 - 954.1
|
INJURY TO CERVICAL SYMPATHETIC NERVE EXCLUDING SHOULDER AND PELVIC GIRDLES - INJURY TO OTHER SYMPATHETIC NERVE EXCLUDING SHOULDER AND PELVIC GIRDLES |
|
954.8 - 954.9
|
INJURY TO OTHER SPECIFIED NERVE(S) OF TRUNK EXCLUDING SHOULDER AND PELVIC GIRDLES - INJURY TO UNSPECIFIED NERVE OF TRUNK EXCLUDING SHOULDER AND PELVIC GIRDLES |
|
955.0 - 955.9
|
INJURY TO AXILLARY NERVE - INJURY TO UNSPECIFIED NERVE OF SHOULDER GIRDLE AND UPPER LIMB |
|
956.0 - 956.5
|
INJURY TO SCIATIC NERVE - INJURY TO OTHER SPECIFIED NERVE(S) OF PELVIC GIRDLE AND LOWER LIMB |
|
956.8 - 956.9
|
INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB - INJURY TO UNSPECIFIED NERVE OF PELVIC GIRDLE AND LOWER LIMB |
|
957.0 - 957.1
|
INJURY TO SUPERFICIAL NERVES OF HEAD AND NECK - INJURY TO OTHER SPECIFIED NERVE(S) |
|
957.8 - 957.9
|
INJURY TO MULTIPLE NERVES IN SEVERAL PARTS - INJURY TO NERVES UNSPECIFIED SITE |
|
Medicare is establishing the following limited coverage for CPT/HCPCS codes 95870, 95872, 95904 and 95933 (non-cranial EMG and NCS):
Covered for:
| 037 |
TETANUS |
|
192.2 - 192.3
|
MALIGNANT NEOPLASM OF SPINAL CORD - MALIGNANT NEOPLASM OF SPINAL MENINGES |
|
250.60 - 250.63
|
DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED |
| 265.1 |
OTHER AND UNSPECIFIED MANIFESTATIONS OF THIAMINE DEFICIENCY |
| 269.1 |
DEFICIENCY OF OTHER VITAMINS |
| 335.0 |
WERDNIG-HOFFMANN DISEASE |
|
335.10 - 335.11
|
SPINAL MUSCULAR ATROPHY UNSPECIFIED - KUGELBERG-WELANDER DISEASE |
| 335.19 |
OTHER SPINAL MUSCULAR ATROPHY |
|
335.20 - 335.24
|
AMYOTROPHIC LATERAL SCLEROSIS - PRIMARY LATERAL SCLEROSIS |
| 335.29 |
OTHER MOTOR NEURON DISEASES |
|
335.8 - 335.9
|
OTHER ANTERIOR HORN CELL DISEASES - ANTERIOR HORN CELL DISEASE UNSPECIFIED |
|
336.0 - 336.3
|
SYRINGOMYELIA AND SYRINGOBULBIA - MYELOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE |
|
336.8 - 336.9
|
OTHER MYELOPATHY - UNSPECIFIED DISEASE OF SPINAL CORD |
|
337.0 - 337.1
|
IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY - PERIPHERAL AUTONOMIC NEUROPATHY IN DISORDERS CLASSIFIED ELSEWHERE |
|
337.20 - 337.22
|
REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED - REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB |
| 337.29 |
REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE |
| 337.3 |
AUTONOMIC DYSREFLEXIA |
| 337.9 |
UNSPECIFIED DISORDER OF AUTONOMIC NERVOUS SYSTEM |
| 340 |
MULTIPLE SCLEROSIS |
|
341.0 - 341.1
|
NEUROMYELITIS OPTICA - SCHILDER'S DISEASE |
|
341.8 - 341.9
|
OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM - DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM UNSPECIFIED |
|
342.00 - 342.02
|
FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - FLACCID HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE |
|
342.10 - 342.12
|
SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE |
|
342.80 - 342.82
|
OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - OTHER SPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE |
|
342.90 - 342.92
|
UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE |
|
343.0 - 343.4
|
CONGENITAL DIPLEGIA - INFANTILE HEMIPLEGIA |
|
343.8 - 343.9
|
OTHER SPECIFIED INFANTILE CEREBRAL PALSY - INFANTILE CEREBRAL PALSY UNSPECIFIED |
|
344.00 - 344.04
|
QUADRIPLEGIA UNSPECIFIED - QUADRIPLEGIA C5-C7 INCOMPLETE |
| 344.09 |
OTHER QUADRIPLEGIA |
|
344.1 - 344.2
|
PARAPLEGIA - DIPLEGIA OF UPPER LIMBS |
|
344.30 - 344.32
|
MONOPLEGIA OF LOWER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE |
|
344.40 - 344.42
|
MONOPLEGIA OF UPPER LIMB AFFECTING UNSPECIFIED SIDE - MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SDE |
| 344.5 |
UNSPECIFIED MONOPLEGIA |
|
344.60 - 344.61
|
CAUDA EQUINA SYNDROME WITHOUT NEUROGENIC BLADDER - CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER |
| 344.81 |
LOCKED-IN STATE |
| 344.89 |
OTHER SPECIFIED PARALYTIC SYNDROME |
| 344.9 |
PARALYSIS UNSPECIFIED |
|
353.0 - 353.6
|
BRACHIAL PLEXUS LESIONS - PHANTOM LIMB (SYNDROME) |
|
353.8 - 353.9
|
OTHER NERVE ROOT AND PLEXUS DISORDERS - UNSPECIFIED NERVE ROOT AND PLEXUS DISORDER |
|
354.0 - 354.5
|
CARPAL TUNNEL SYNDROME - MONONEURITIS MULTIPLEX |
|
354.8 - 354.9
|
OTHER MONONEURITIS OF UPPER LIMB - MONONEURITIS OF UPPER LIMB UNSPECIFIED |
|
355.0 - 355.6
|
LESION OF SCIATIC NERVE - LESION OF PLANTAR NERVE |
| 355.71 |
CAUSALGIA OF LOWER LIMB |
| 355.79 |
OTHER MONONEURITIS OF LOWER LIMB |
|
355.8 - 355.9
|
MONONEURITIS OF LOWER LIMB UNSPECIFIED - MONONEURITIS OF UNSPECIFIED SITE |
|
356.0 - 356.4
|
HEREDITARY PERIPHERAL NEUROPATHY - IDIOPATHIC PROGRESSIVE POLYNEUROPATHY |
|
356.8 - 356.9
|
OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY - UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY |
|
357.0 - 357.7
|
ACUTE INFECTIVE POLYNEURITIS - POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS |
|
357.81 - 357.82
|
CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS - CRITICAL ILLNESS POLYNEUROPATHY |
| 357.89 |
OTHER INFLAMMATORY AND TOXIC NEUROPATHY |
|
358.00 - 358.01
|
MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION - MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION |
|
358.1 - 358.2
|
MYASTHENIC SYNDROMES IN DISEASES CLASSIFIED ELSEWHERE - TOXIC MYONEURAL DISORDERS |
|
358.8 - 358.9
|
OTHER SPECIFIED MYONEURAL DISORDERS - MYONEURAL DISORDERS UNSPECIFIED |
|
359.0 - 359.6
|
CONGENITAL HEREDITARY MUSCULAR DYSTROPHY - SYMPTOMATIC INFLAMMATORY MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE |
| 359.81 |
CRITICAL ILLNESS MYOPATHY |
| 359.89 |
OTHER MYOPATHIES |
| 359.9 |
MYOPATHY UNSPECIFIED |
| 438.32 |
MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SIDE |
|
438.41 - 438.42
|
MONOPLEGIA OF LOWER LIMB AFFECTING DOMINANT SIDE - MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE |
|
710.3 - 710.5
|
DERMATOMYOSITIS - EOSINOPHILIA MYALGIA SYNDROME |
|
721.1 - 721.3
|
CERVICAL SPONDYLOSIS WITH MYELOPATHY - LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY |
|
721.41 - 721.42
|
SPONDYLOSIS WITH MYELOPATHY THORACIC REGION - SPONDYLOSIS WITH MYELOPATHY LUMBAR REGION |
| 721.91 |
SPONDYLOSIS OF UNSPECIFIED SITE WITH MYELOPATHY |
| 722.0 |
DISPLACEMENT OF CERVICAL INTERVERTEBRAL DISC WITHOUT MYELOPATHY |
|
722.10 - 722.11
|
DISPLACEMENT OF LUMBAR INTERVERTEBRAL DISC WITHOUT MYELOPATHY - DISPLACEMENT OF THORACIC INTERVERTEBRAL DISC WITHOUT MYELOPATHY |
| 722.2 |
DISPLACEMENT OF INTERVERTEBRAL DISC SITE UNSPECIFIED WITHOUT MYELOPATHY |
|
722.70 - 722.73
|
INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY UNSPECIFIED REGION - INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY LUMBAR REGION |
|
722.80 - 722.83
|
POSTLAMINECTOMY SYNDROME OF UNSPECIFIED REGION - POSTLAMINECTOMY SYNDROME OF LUMBAR REGION |
|
723.0 - 723.5
|
SPINAL STENOSIS IN CERVICAL REGION - TORTICOLLIS UNSPECIFIED |
|
724.00 - 724.02
|
SPINAL STENOSIS OF UNSPECIFIED REGION - SPINAL STENOSIS OF LUMBAR REGION |
| 724.09 |
SPINAL STENOSIS OF OTHER REGION |
| 724.1 |
PAIN IN THORACIC SPINE |
|
724.3 - 724.4
|
SCIATICA - THORACIC OR LUMBOSACRAL NEURITIS OR RADICULITIS UNSPECIFIED |
| 728.0 |
INFECTIVE MYOSITIS |
| 728.88 |
RHABDOMYOLYSIS |
| 729.5 |
PAIN IN LIMB |
|
736.05 - 736.06
|
WRIST DROP (ACQUIRED) - CLAW HAND (ACQUIRED) |
| 781.0 |
ABNORMAL INVOLUNTARY MOVEMENTS |
|
781.2 - 781.3
|
ABNORMALITY OF GAIT - LACK OF COORDINATION |
| 781.6 |
MENINGISMUS |
| 782.0 |
DISTURBANCE OF SKIN SENSATION |
| 784.49 |
OTHER VOICE DISTURBANCE |
| 951.4 |
INJURY TO FACIAL NERVE |
|
951.6 - 951.7
|
INJURY TO ACCESSORY NERVE - INJURY TO HYPOGLOSSAL NERVE |
|
952.00 - 952.09
|
C1-C4 LEVEL SPINAL CORD INJURY UNSPECIFIED - C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY |
|
952.10 - 952.19
|
T1-T6 LEVEL SPINAL CORD INJURY UNSPECIFIED - T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY |
|
952.2 - 952.4
|
LUMBAR SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY - CAUDA EQUINA SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY |
|
952.8 - 952.9
|
MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY - UNSPECIFIED SITE OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY |
|
953.0 - 953.5
|
INJURY TO CERVICAL NERVE ROOT - INJURY TO LUMBOSACRAL PLEXUS |
|
953.8 - 953.9
|
INJURY TO MULTIPLE SITES OF NERVE ROOTS AND SPINAL PLEXUS - INJURY TO UNSPECIFIED SITE OF NERVE ROOTS AND SPINAL PLEXUS |
|
954.0 - 954.1
|
INJURY TO CERVICAL SYMPATHETIC NERVE EXCLUDING SHOULDER AND PELVIC GIRDLES - INJURY TO OTHER SYMPATHETIC NERVE EXCLUDING SHOULDER AND PELVIC GIRDLES |
|
954.8 - 954.9
|
INJURY TO OTHER SPECIFIED NERVE(S) OF TRUNK EXCLUDING SHOULDER AND PELVIC GIRDLES - INJURY TO UNSPECIFIED NERVE OF TRUNK EXCLUDING SHOULDER AND PELVIC GIRDLES |
|
955.0 - 955.9
|
INJURY TO AXILLARY NERVE - INJURY TO UNSPECIFIED NERVE OF SHOULDER GIRDLE AND UPPER LIMB |
|
956.0 - 956.5
|
INJURY TO SCIATIC NERVE - INJURY TO OTHER SPECIFIED NERVE(S) OF PELVIC GIRDLE AND LOWER LIMB |
|
956.8 - 956.9
|
INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB - INJURY TO UNSPECIFIED NERVE OF PELVIC GIRDLE AND LOWER LIMB |
|
957.0 - 957.1
|
INJURY TO SUPERFICIAL NERVES OF HEAD AND NECK - INJURY TO OTHER SPECIFIED NERVE(S) |
|
957.8 - 957.9
|
INJURY TO MULTIPLE NERVES IN SEVERAL PARTS - INJURY TO NERVES UNSPECIFIED SITE |
|
Medicare is establishing the following limited coverage for CPT/HCPCS codes 95903, 95934 and 95936 (F-wave and H-reflex):
Covered for:
|
192.2 - 192.3
|
MALIGNANT NEOPLASM OF SPINAL CORD - MALIGNANT NEOPLASM OF SPINAL MENINGES |
|
353.0 - 353.1
|
BRACHIAL PLEXUS LESIONS - LUMBOSACRAL PLEXUS LESIONS |
| 353.4 |
LUMBOSACRAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED |
|
354.1 - 354.5
|
OTHER LESION OF MEDIAN NERVE - MONONEURITIS MULTIPLEX |
|
354.8 - 354.9
|
OTHER MONONEURITIS OF UPPER LIMB - MONONEURITIS OF UPPER LIMB UNSPECIFIED |
|
355.0 - 355.4
|
LESION OF SCIATIC NERVE - LESION OF MEDIAL POPLITEAL NERVE |
| 355.6 |
LESION OF PLANTAR NERVE |
| 355.71 |
CAUSALGIA OF LOWER LIMB |
| 355.79 |
OTHER MONONEURITIS OF LOWER LIMB |
|
355.8 - 355.9
|
MONONEURITIS OF LOWER LIMB UNSPECIFIED - MONONEURITIS OF UNSPECIFIED SITE |
|
356.0 - 356.4
|
HEREDITARY PERIPHERAL NEUROPATHY - IDIOPATHIC PROGRESSIVE POLYNEUROPATHY |
|
356.8 - 356.9
|
OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY - UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY |
|
357.0 - 357.7
|
ACUTE INFECTIVE POLYNEURITIS - POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS |
|
357.81 - 357.82
|
CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS - CRITICAL ILLNESS POLYNEUROPATHY |
| 357.89 |
OTHER INFLAMMATORY AND TOXIC NEUROPATHY |
| 357.9 |
UNSPECIFIED INFLAMMATORY AND TOXIC NEUROPATHIES |
| 721.1 |
CERVICAL SPONDYLOSIS WITH MYELOPATHY |
|
721.41 - 721.42
|
SPONDYLOSIS WITH MYELOPATHY THORACIC REGION - SPONDYLOSIS WITH MYELOPATHY LUMBAR REGION |
| 723.4 |
BRACHIAL NEURITIS OR RADICULITIS NOS |
|
724.3 - 724.4
|
SCIATICA - THORACIC OR LUMBOSACRAL NEURITIS OR RADICULITIS UNSPECIFIED |
|
781.2 - 781.3
|
ABNORMALITY OF GAIT - LACK OF COORDINATION |
|
953.2 - 953.3
|
INJURY TO LUMBAR NERVE ROOT - INJURY TO SACRAL NERVE ROOT |
| 953.5 |
INJURY TO LUMBOSACRAL PLEXUS |
|
956.0 - 956.5
|
INJURY TO SCIATIC NERVE - INJURY TO OTHER SPECIFIED NERVE(S) OF PELVIC GIRDLE AND LOWER LIMB |
|
956.8 - 956.9
|
INJURY TO MULTIPLE NERVES OF PELVIC GIRDLE AND LOWER LIMB - INJURY TO UNSPECIFIED NERVE OF PELVIC GIRDLE AND LOWER LIMB |
|
Medicare is establishing the following limited coverage for CPT/HCPCS add-on codes 95873 and 95874 when EMG is used for directed treatment of botulinum toxin injections (J0585 and J0587):
Covered for:
| 333.6 |
GENETIC TORSION DYSTONIA |
|
333.71 - 333.79
|
ATHETOID CEREBRAL PALSY - OTHER ACQUIRED TORSION DYSTONIA |
|
333.82 - 333.84
|
OROFACIAL DYSKINESIA - ORGANIC WRITERS' CRAMP |
| 333.89 |
OTHER FRAGMENTS OF TORSION DYSTONIA |
| 340 |
MULTIPLE SCLEROSIS |
| 341.9 |
DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM UNSPECIFIED |
| 342.11 |
SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING DOMINANT SIDE |
| 343.9 |
INFANTILE CEREBRAL PALSY UNSPECIFIED |
| 351.8 |
OTHER FACIAL NERVE DISORDERS |
| 625.6 |
STRESS INCONTINENCE FEMALE |
| 728.85 |
SPASM OF MUSCLE |
|
|
| |
| Diagnoses that Support Medical Necessity back to top |
| See above |
| |
| ICD-9 Codes that DO NOT Support Medical Necessity back to top |
All not listed above
|
| |
| ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation back to top |
| |
| |
| Diagnoses that DO NOT Support Medical Necessity back to top |
| All not listed above |
|
| General Information |
|
|
| Documentation Requirements back to top |
Documentation supporting the medical necessity should be legible, maintained in the patients medical record and be made available to Medicare upon request. Refer to the table under Indications and Limitations of Coverage and/or Medical Necessity for specific documentation requirements.
It is expected that the NCT and EMG reports will contain data from the study as well as the interpretation and diagnosis.
In the event of a review for medical necessity, the patients medical record must support the need for the studies performed. The number of limbs or areas tested should be the minimum needed to evaluate the patients condition. Repeat testing should be infrequent, limitation of testing services will be determined on the basis of individual medical necessity. However, documentation of services exceeding the CIGNA Government Servcies guidelines or the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines must be verifiable, and clearly documented in the patient's medical record, with the documentation justifying all testing that exceeds recommended parameters. An excessive number of services may result in a delay in processing, a denial of the claim, or a request for a refund.
Credentials of providers billing for NCTs and/or EMG must be available on request.
The record must reflect the need for EMG to localize the optimal injection site for the botulinum toxin, and the dose injected and any reported wastage must be recorded in the record.
|
| |
| Appendices back to top |
| |
| |
| Utilization Guidelines back to top |
Refer to the table under Indications and Limitations of Coverage for specific number of sites tested per study limits.
It is expected that providers will use code 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 codes 95860, 95861, 95863, or 95864 are also billed.
Medicare would not expect to see multiple uses of EMG in the same patient at the same location for the purpose of optimizing botulinum toxin injections.
|
| |
| Sources of Information and Basis for Decision back to top |
Aminoff, M.J. Electrodiagnosis in Clinical Neurology. 3rd ed. New York; Churchill Livingstone, 1992.
Brown, W.F. and C.F. Bolton. Clinical Electromyography. 2nd ed. Boston; Butterworths, 1993
DeLisa, J.A., et al. Manual of Nerve Conduction Velocity and Clinical Neurophysiology. 3rd ed. New York: Raven Press, 1994
Dumitru, D. Electrodiagnostic Medicine. Philadelphia: Hanley & Belfus, 1995
Oh, S.J. Clinical Electromyography: Nerve Conduction Studies. 2nd ed. Baltimore: Williams & Wilkins, 1993
Kimura, J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 2nd ed. Philadelphia: FA Davis, 1989
"Laboratory Tests in End-Stage Renal Disease Patients Undergoing Dialysis." AHCPR #94-0053. Health Technology Assessment Publication number 2, May 1994
Suggested Reference List available from American Association of Electrodiagnostic Medicine (AAEM) at 21 Second Street S.W.
"Who is Qualified to Practice Electrodiagnostic Medicine?" American Association of Electrodiagnostic Medicine. Includes position statements from (A) American Medical Association. House of Delegates, Resolutions: G2, I-83, 1983. (B) American Academy of Neurology. Minutes of Executive Board Meeting 11.9 (1) December 2, 1981. (C)American Academy of Physical Medicine and Rehabilitation. Statement re: Clinical Diagnostic Electromyography, November 1983. (D) Veterans' Administration Professional Services Letter: Professional Qualifications for Performing Electromyographic Examinations IL-11-80-1, January 4, 1980. American Board of Physical Therapy Specialities. Copyright 1995.
The two preceding references are also available from AAEM Web site URL: http:/www.pitt.edu/-nab4/aaem.html
AAEM Monographs. These provide detailed discussions with bibliography covering individual topics in the field of electrodiagnosis. They are available from AAEM or from the Web site cited above.
Nathan, D.M. 1996. "The pathophysiology of diabetic complications: How much does the glucose hypothesis explain?" New England Journal of Medicine 329:977-986.
"Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin dependent diabetes mellitus." 1993, New England J of Med 329: 977-986.
Other carriers’ policies: First Coast - Florida, Empire - downstate New York, HGSA Administrators - Pennsylvania, Trailblazer - Texas. |
| |
| Advisory Committee Meeting Notes back to top |
| Presented to the North Carolina CAC Meeting, October 12, 2006. This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from Neurology and other specialties. This policy was developed in consultation with the medical community via the Carrier Advisory Committee. |
| |
| Start Date of Comment Period back to top |
| 10/12/2006 |
| |
| End Date of Comment Period back to top |
| 11/27/2006 |
| |
| Start Date of Notice Period back to top |
| 11/28/2006 |
| |
| Revision History Number back to top |
| 00 |
| |
| Revision History Explanation back to top |
| Making final updates to draft |
| |
| Reason for Change back to top |
|
|
| Last Reviewed On Date back to top |
| |
| |
| Related Documents back to top |
Article(s)
A43091 - Nerve Conduction Studies and Electromyography
|
| |
| LCD Attachments back to top |
| There are no attachments for this LCD. |
|
|
Read the LCD Disclaimer
 Add to basket
|
 Email this to a friend
|
 New Search
Page Last Modified: 8/13/2009 3:51:04 PM
Help with File Formats and Plug-Ins
Submit Feedback
|
Email
Print