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Local Coverage Determination (LCD)

Somatosensory Testing

L34624

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L34624
Original ICD-9 LCD ID
Not Applicable
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 10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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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.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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Issue

Issue Description

This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity.
Issue - Explanation of Change Between Proposed LCD and Final LCD

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not
reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the
functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary
information to process the claim.

Code of Federal Regulations:

42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific
medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

CMS Publications:

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests

CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2: Section 160.23 Sensory Nerve Conduction Threshold Tests (sNCTs)

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 23 - Fee Schedule Administration and Coding Requirements: Section 10 - Reporting ICD Diagnosis and Procedure Codes

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Abstract:
Short-latency somatosensory evoked potentials (SEPs) represent electrophysiologic responses of the somatosensory pathways to stimulation. Somatosensory testing involves the application of a series of brief electrical stimuli over peripheral nerves (e.g., the median, peroneal, and tibial nerves) and recording the resulting evoked potentials over proximal portions of the nerves and central pathways which were stimulated, the plexus, spine and/or scalp. Action potentials recorded from these sites are averaged by a computer to improve signal clarity and then displayed in standard formats on the computer’s screen as well as in printed form.

A provider trained in interpreting clinical evoked potential studies analyzes the waveforms. The waveforms obtained should be described by nerve being stimulated, the recording sites, peak latencies, interpeak intervals (when appropriate), and amplitudes of the significant components. The nerves most commonly stimulated are the median nerve at the wrist for testing in the upper extremity, and the posterior tibial nerve at the ankle or common peroneal nerve (CPN) at the knee for the lower extremity.

SEPs evaluate the entire somatosensory pathway from the site of stimulation up to the cerebral cortex. It is possible to distinguish between lesions located in the peripheral nerve, in the dorsal column spinal cord pathway, or higher centers in the brain up through the cortex. In general, there is no need for SEP in the diagnosis of most peripheral neuropathies because the conventional nerve conduction studies or needle EMG can identify these types of lesions and no added information is obtained from SEP. This local coverage determination discusses medically necessary indications and limitations for SEPs.

Indications:
Medicare will consider the use of short-latency somatosensory evoked potentials to be medically reasonable and necessary to assist in the diagnosis of certain neuropathologic states (as described below) to provide information for treatment decisions and for intraoperative electrophysiological monitoring during spinal surgeries in which there is risk of additional nerve or spinal cord injury. However, it is not anticipated that such monitoring will be medically necessary for the typical cervical or lumbar root decompression procedures.

SEPs are used to evaluate the more proximal segments of nerves and the integrity of the central somatosensory pathways when abnormality of conduction through the brain and/or brainstem, spinal cord, and/or peripheral nerves is suspected. This utilization would include conditions such as multiple sclerosis, cervical spondylosis with myelopathy, coma, spinal cord trauma, 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 appropriate diagnostic tests such as imaging studies, electromyogram, and nerve conduction studies make a lesion (or lesions) of the central somatosensory pathways a likely and reasonable differential diagnostic possibility.

 
Summary of Evidence

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Analysis of Evidence (Rationale for Determination)

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Proposed Process Information

Synopsis of Changes
Changes Fields Changed
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Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
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Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
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CPT/HCPCS Codes

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Group 1

Group 1 Paragraph

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 Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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Group 1

Group 1 Paragraph:

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 Group 1 Codes:

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

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Group 1

Group 1 Paragraph:

N/A

 Group 1 Codes:

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Additional ICD-10 Information

General Information

Associated Information

Documentations Requirements
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD and associated Billing and Coding Article. This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Medical record documentation maintained by the performing provider must clearly indicate the medical necessity of the service being billed. There should be evidence in the medical record that the test results were noted and influenced or contributed to the patient’s course of treatment. In addition, documentation that the service was performed must be included in the patient’s medical record. This documentation should include a hard copy computer generated recording of the test results along with the provider’s interpretation. The provider’s SEP report should note which nerves were tested, latencies at various testing points, and an evaluation of whether the resulting values are normal or abnormal. This information is normally found in the office/progress notes, hospital records, and/or procedure notes.

If the provider of somatosensory testing is other than the ordering or referring physician or nonphysician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies.

Providers of interpretations, supervision and performance of the technical portions of the studies must be capable of demonstrating documented training and experience for post-payment audit.

Utilization Guidelines
It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.
Sources of Information
N/A
Bibliography

Kraft, G.H., Aminoff, M.J., Baran, E.M., Litchy, W.J., Stolov, W.C. Somatosensory evoked potentials: Clinical uses. Muscle Nerve. 1998;21(2):252-258.

AANEM. (2019). Recommended Policy for electrodiagnostic medicine [position statement] Retrieved from https://www.aanem.org/Advocacy/Position-Statements/Recommended-Policy-for-Electrodiagnostic-Medicine. Accessed 22 September 2021.

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
10/01/2023 R16

Posted 09/28/2023 Review completed 08/15/2023 with no changes to coverage.
  • Other (Review)
10/28/2021 R15

10/28/2021 Moved Sources of Information to Bibliography and corrected to AMA formatting. Punctuation and grammatical errors corrected throughout document. Review completed 9/22/2021.
  • Other (Review)
11/01/2019 R14

11/01/2019 Change Request 10901 Local Coverage Determinations (LCDs): it will no longer be appropriate to include Current Procedure Terminology (CPT)/Health Care Procedure Coding System (HCPCS) codes or International Classification of Diseases Tenth Revision-Clinical Modification (ICD-10-CM) codes in the LCDs. All CPT/HCPCS, ICD-10 codes, and Billing and Coding Guidelines have been removed from this LCD and placed in the Billing and Coding Article related to this LCD. Consistent with Change Request 10901, if any language from IOMs and/or regulations was present in the LCD, it has been removed and the applicable manual/regulation has been referenced. Typographic error corrected. Review completed 10/22/2019. 
  • Other (Changes in response to CMS Change Request 10901, Review completed.

    )
10/01/2019 R13

09/26/2019 Description change to Revenue Code 0964 to Professional Fees – Anesthetist (CRNA).
  • Revisions Due To ICD-10-CM Code Changes
  • Other
12/01/2018 R12

12/01/2018 Coverage Guidance and Documentation sections: changed “physician” to “provider”.
In Coverage Guidelines: removed the sentence: “It is anticipated only allopathic or osteopathic physicians will have the necessary training to meet these requirements.”
In training and expertise: added the following verbiage to sentence “certification by a nationally recognized organization, or by an accredited post-graduate training course covering anatomy, neurophysiology and forms of electrodiagnostics (including both NCS and EMG) and the definition of Physician Supervision Indicator “09” for clarification.”
  • Other
10/01/2018 R11

10/01/2018 ICD-10 Code Updates: deleted I63.8 and added I63.81 and I63.89 to Group One. Description changes: I63.333, I63.343, and M50.01 in Group One.
  • Revisions Due To ICD-10-CM Code Changes
09/01/2018 R10

09/01/2018 Annual review completed 08/07/2018 with no change in coverage. Typographical error corrected. Formatting change made.
  • Other (Annual Review )
12/01/2017 R9

 

12/01/2017 Added to revision history: 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. No change in coverage.

 
  • Other
10/01/2017 R8

10/01/2017 ICD-10 Code Updates: To Group 1: Deleted M48.06; Added: G12.23, G12.24, G12.25, M48.061, M48.062, with description changes to: I63.211, I63.212, I63.22, I63.323, I63.333, I63.513, I63.523, and I63.533. Annual review completed 08/31/2017. Added verbiage from CMS Publication 100-02 Medicare Benefit Policy Manual and Publication 100-04, Medicare Claims Processing Manual.  Typographical error corrected.
  • Typographical Error
  • Other (Annual review)
10/01/2016 R7 10/01/2016 ICD-CM Code updates Group 1 added codes I60.2, I63.013, I63.033, I63.113, I63.133, I63.213, I63.233, I63.313, I63.323, I63.333, I63.343, I63.413, I63.423, I63.433, I63.443, I63.513, I63.523, I63.533, I63.543, M50.021, M50.022, M50.023. Deleted codes: I60.21, I60.22, M50.02. Description change I77.79. Group 2 Deleted codes: S06.0X6A. Description change S54.8X1A and S54.8X2A. Annual review no other changes.
  • Revisions Due To ICD-10-CM Code Changes
04/01/2016 R6 04/01/2016 Removed CAC information no change in coverage.
  • Other
10/01/2015 R5 10/01/2015- Annual review no change in coverage.
  • Other (Maintenance annual review)
10/01/2015 R4 05/29/2015 – Annual updates to the Bill Type Codes and Revenue Codes have been reviewed by the Policy Department and are being Approved for public display. No other changes to policy or coverage.
  • Other (Annual Bill Type Code and Revenue Code updates.)
10/01/2015 R3 10/01/2014 Annual Review, updated references. No change to coverage.
  • Other
10/01/2015 R2 08/01/2014 Code description change code M50.01.
  • Other
10/01/2015 R1 07/01/2014 Code updates 2014 removed codes M47.17, M47.18 and M51.07.
  • Revisions Due To ICD-10-CM Code Changes
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Associated Documents

Attachments
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Related Local Coverage Documents
Articles
A57597 - Billing and Coding: Somatosensory Testing
Related National Coverage Documents
NCDs
160.23 - Sensory Nerve Conduction Threshold Tests (sNCTs)
Public Versions
Updated On Effective Dates Status
09/19/2023 10/01/2023 - N/A Currently in Effect You are here
10/19/2021 10/28/2021 - 09/30/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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