Monday, December 21, 2015

Nerve Conduction Studies and Electromyography (A54094)

Electromyography (EMG)

It is expected that providers will use Procedure 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.

Nerve Conduction Studies (NCS)

Nerve conduction studies performed using automated devices (for example devices such as NC-stat® System) should be billed with Procedure code 95905. These studies should not be billed with any other Procedure code. Procedure code 95905 cannot be billed in conjunction with any other nerve conduction codes.

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 Procedure code 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 Procedure 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 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) and section 40.1.)

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.

Other Comments

Refer to LCD, L32723, Nerve Conduction Studies and Electromyography for additional information.

Coding Information 
Bill Type Codes
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 article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999X Not Applicable

Revenue Codes
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 article 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 article should be assumed to apply equally to all Revenue Codes.

Code Description
99999 Not Applicable
Procedure code /HCPCS Codes
Group 1 Paragraph
Electromyography (EMG)
Group 1 Codes:
Code Description
92265 Eye muscle evaluation
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
95874 Guide nerv destr needle emg
95885 Musc tst done w/nerv tst lim
95886 Musc test done w/n test comp
95887 Musc tst done w/n tst nonext
Group 2: Paragraph
Nerve Conduction Studies (NCS)
Group 2: Codes
Code Description
95873 Guide nerv destr elec stim
95905 Motor &/ sens nrve cndj test
95907 Nvr cndj tst 1-2 studies
95908 Nrv cndj tst 3-4 studies
95909 Nrv cndj tst 5-6 studies
95910 Nrv cndj test 7-8 studies
95911 Nrv cndj test 9-10 studies
95912 Nrv cndj test 11-12 studies
95913 Nrv cndj test 13/> studies
95933 Blink reflex test
95937 Neuromuscular junction test
95999 Neurological procedure
G0255 Current percep threshold tst
Covered ICD-9 Codes
Group 1: Paragraph
Refer to LCD, L32723, Nerve Conduction Studies and Electromyography
Group 1: Codes
Code Description
XX000 Not Applicable
Group 2: Paragraph
Refer to LCD, L32723, Nerve Conduction Studies and Electromyography
Group 2: Codes
Code Description
XX000 Not Applicable

Non-Covered ICD-9 Codes
Group 1: Paragraph
Group 1: Codes
Code Description


XX000 Not Applicable

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