Local Coverage Determination (LCD)

Nerve Conduction Studies and Electromyography

L35048

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Contractor Information

LCD Information

Document Information

LCD ID
L35048
LCD Title
Nerve Conduction Studies and Electromyography
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 07/15/2021
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
10/09/2014
Notice Period End Date
11/23/2014
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.

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CMS National Coverage Policy

Title XVIII of the Social Security Act §1862(a)(1)(A) states that no payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act §1861(r)(1) defines the term physician.

Title XVIII of the Social Security Act §1861(s)(2)(A) defines medical and other health services.

42 CFR §410.32(a) indicates that diagnostic tests must be ordered by the treating physician, or other treating practitioner acting within the scope of his or her license and Medicare requirements, who uses the results in the management of the beneficiary's specific medical problem.

42 CFR §410.32(b)(3)(i-iii) defines supervision and the three levels of supervision.

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Palmetto GBA expects that all healthcare professionals involved in the performance of electrodiagnostic (ED) testing, including technicians, will be appropriately trained and/or credentialed, either by a formal residency/fellowship program (physicians), certification by a nationally recognized organization, or by an accredited post-graduate training course covering anatomy, neurophysiology and forms of EDs, such as nerve conduction studies (NCS) and electromyography (EMG) that are acceptable to this contractor, in order to provide the proper testing and assessment of the patient's condition, and appropriate safety measures. It would be highly unlikely that this training and/or credentialing is possessed by providers other than Neurologists, or Physical Medicine & Rehabilitation physicians.

Palmetto GBA also expects that the laboratories in which these studies are performed meet basic safety and quality standards regarding such issues as electrical safety and electrical equipment maintenance, needle handling, blood spill management, etc. Such standards have been established by the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM).

The ED evaluation is an extension of the neurologic portion of the history and physical examination. Both require a detailed knowledge of a patient and his/her disease. Training in the performance of ED procedures in isolation of knowledge about clinical diagnostic and management aspects of neuromuscular diseases may not be adequate for proper performance of an ED evaluation and correct interpretation of ED test results. Without awareness of the patterns of abnormality expected in different diseases and knowledge that the results of NCS and EMG may be similar in different diseases, diagnosis solely by EMG-NCS findings may be both inadequate and ultimately be detrimental to the patient.

Guidelines about proper qualifications for qualified health care professionals performing ED evaluations have been developed and published by AANEM and other medical organizations, including the American Medical Association (AMA), the American Academy of Neurology (AAN), the American Academy of Physical Medicine and Rehabilitation (AAPMR), American Neurological Association (ANA), the American Board of Physical Therapy Specialties (ABPTS) in Clinical Electrophysiology, and the Department of Veterans Affairs (VA).

Both EMGs and NCSs are usually required for a clinical diagnosis of peripheral nervous system disorders. Performance of one type of testing does not eliminate the need for the other. The intensity and extent of testing with EMG and NCS are matters of clinical judgment developed after the initial pre-test evaluation, and later modified during the testing procedure. Palmetto GBA expects that EMG’s will be conducted in conjunction with nerve conduction velocity (NCV) in all testing instances. The only exception would be in situations where a contraindication to performing an EMG exists. In such cases, the circumstances for the contraindication should be clearly documented in the medical record.

It is expected that only an appropriate and sufficient number of ED studies will be performed to arrive at an appropriate diagnosis. The AANEM has published a “Model Policy for Needle EMG and NCS” outlining recommendations pertaining to a reasonable maximum number of studies, per diagnostic indication, necessary for a practitioner to arrive at a diagnosis in 90% of patients with that final diagnosis. It is recommended that the ED provider utilize this table as a guideline when performing testing.

Decisions to continue, modify or conclude an EMG/NCS test rely on knowledge of anatomy, physiology and neuromuscular diseases. Ongoing real-time assessment of data is required during the clinical diagnostic evaluation and especially during EMG examination. As such, the provider performing the testing and/or interpretation should be present on the site and immediately available during the examination.

NCS are used to measure action potentials resulting from peripheral nerve stimulation which are recordable over the nerve or from an innervated muscle. With this technique, responses are measured between two sites of stimulation, or between a stimulus and a recording site.

NCS are of two general types: sensory and motor. Either surface or needle electrodes can be used to stimulate the nerve or record the response. Axonal damage or dysfunction generally results in loss of nerve or muscle potential response amplitude; whereas, demyelination leads to prolongation of conduction time and slowing of conduction velocity.

Obtaining and interpreting NCS results requires extensive interaction between the performing qualified health care professional and patient, and is most effective when both obtaining raw data and interpretation are performed concurrently on a real-time basis.

Results of the NCS reflect on the integrity and function of:

         (I) the myelin sheath (Schwann cell derived insulation covering an axon), and

         (II) the axon (an extension of neuronal cell body) of a nerve.

Interruption of axon and dysfunction of myelin will both affect NCS results.

It is often also valuable to test conduction status in proximal segments of peripheral nerves. This assessment can be accomplished by H-reflex, F-wave and blink reflex testing. These proximal segments include the first several centimeters of a compound nerve emerging from the spinal cord or brainstem. H-reflex, F-waves and Blink reflex testing accomplish this task better than distal NCS.

EMG is the study and recording of intrinsic electrical properties of skeletal muscles. This is carried out with a needle electrode. Generally, the needles are of two types: monopolar or concentric. EMG is undertaken together with NCS. Unlike NCS, however, EMG testing relies on both auditory and visual feedback to the electromyographer. This testing is also invasive in that it requires needle electrode insertion and adjustment at multiple sites, and at times anatomically critical sites. As in NCS, during EMG studies the electromyographer depends on ongoing real-time interpretation based knowledge of the clinical diagnosis being evaluated to decide whether to continue, modify, or conclude a test. This process requires knowledge of anatomy, physiology, and neuromuscular diseases.

EMG results reflect not only on the integrity of the functioning connection between a nerve and its innervated muscle but also on the integrity of a muscle itself. The axon innervating a muscle is primarily responsible for the muscle’s volitional contraction, survival, and trophic functions. Thus, interruption of the axon will alter the EMG. A few prime examples of conditions in which EMG is potentially helpful are disc disease producing spinal nerve dysfunction, advanced nerve compression in peripheral lesions, Amyotrophic Lateral Sclerosis (ALS), polyneuropathy, etc. After an acute neurogenic lesion, EMG changes may not appear for several days to weeks in the innervated muscles. Primary muscle disease such as polymyositis will also alter a normal EMG pattern. Myotonic disorders may show a pattern of spontaneous repetitive discharges on needle exploration.

In summary, axonal and muscle involvement are most sensitively detected by EMGs, and myelin and axonal involvement are best detected by NCSs.

A. Nerve Conduction Studies
The dichotomy into axonal and demyelinating neuropathies provides a practical means of correlating electrical abnormalities with major pathophysiologic changes in the nerve. Electrical studies can be of help in localization of an abnormality, and in distinguishing one variety of neuropathy from another: for example, diffuse vs. multifocal; axonal vs. demyelinating. Such distinction has diagnostic value. Specific classification of nerve injuries into neuropraxia and axonotmesis can be made on the basis of conduction studies and EMG. Such classification has a bearing on prognosis and treatment.

  1. Focal neuropathies or compressive lesions such as carpal tunnel syndrome, ulnar neuropathies or root lesions, for localization.
  2. Traumatic nerve lesions, for diagnosis and prognosis.
  3. Diagnosis or confirmation of suspected generalized neuropathies, such as diabetic, uremic, metabolic or immune.
  4. Repetitive nerve stimulation in the diagnosis of neuromuscular junction disorders such as myasthenia gravis, myasthenic syndrome.
  5. There may be other instances, not detailed here, where NCS may be of use. Not all possible or potential indications are addressed here.

The broad diagnostic scope of NCS is recognizable by the foregoing description. There may be instances where questions about an indication, or need for a study, will arise. The clinical history and examination, carried out before the study, must always describe and document clearly and comprehensibly the need for the planned test. A "rule-out" diagnosis is typically not acceptable. The contractor is cognizant of the fact that patients are not always referred with a definite diagnosis in mind. Often, pain, paresthesia, or weakness in an extremity is the reason for an NCS or EMG. These common symptoms result not only from axonal and myelin dysfunction but also from systemic, non-neurological illnesses. EMG and NCV may help in making this distinction. Therefore, symptom-based diagnoses such as "pain in limb" weakness, disturbance in skin sensation or "paresthesia" are acceptable provided the clinical assessment unequivocally supports the need for a study. To cite but one example of many, an EMG or NCS is irrelevant as a first order diagnostic test for limb pain resulting from immediate antecedent trauma or acute bone injury.

Both EMGs and NCSs are required for a clinical diagnosis of peripheral nervous system disorders. EMG results reflect on the integrity of the functioning connection between a nerve and its innervated muscle and also on the integrity of a muscle itself. Performance of one does not eliminate the need for the other. The intensity and extent of testing with EMG and NCS are matters of clinical judgment developed after the initial pre-test evaluation, and later modified during the testing procedure.

Decisions to continue, modify or conclude a test also rely on a knowledge base of anatomy, physiology and neuromuscular diseases. There is a requirement for ongoing real-time clinical diagnostic evaluation, especially during EMG examination. Also, EMG examination is invasive. Needle placement in the exact muscle of interest is essential. It requires needle exploration near vital structures such as the pleura, femoral neurovascular bundle, peritoneum, intraspinal spaces, carotid artery, orbit and brachial plexus. Risk of infection from AIDS, Hepatitis B-E, Creutzfeldt-Jakob encephalopathy, and hemorrhage from anticoagulation can be managed by proper techniques.

The ED evaluation is actually an extension of the neurologic portion of the physical examination. Both require a detailed knowledge of a patient and his/her disease. Training in the performance of ED procedures, in isolation without awareness and ability to diagnose and manage neuromuscular diseases, is not always adequate for ED consultation. Recognition and experience in the management of disparate diseases that produce common ED findings may be necessary. For example, EMG-NCS findings may overlap in the following pairs of disorders: inflammatory myopathies and ALS, ALS and multi-level radiculopathies, myotonia of channelopathies (periodic paralyses) and myotonic dystrophies, focal neuropathies such as Carpal Tunnel Syndrome and proximal plexopathies. Other instances where knowledge of disease behavior is crucial are Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and Multifocal Motor Neuropathy. These entities display ED features that resemble generalized polyneuropathies. Neuromuscular transmission disorders require separation based on clinical presentation and electrical features. Treatment will depend on differentiating among them. Without awareness of the disease spectrum, diagnosis solely by EMG-NCS findings may be either wrong or detrimental to the patient.

The following definitions are from the AANEM Recommended Policy for Electrodiagnostic Medicine.

The stimulation of nerves is similar across all NCSs; the characteristics of motor, sensory, and mixed NCSs are different and are discussed separately below. In each case, an appropriate nerve is stimulated and recording is made either from the appropriate nerves or from muscle supplied by the motor nerve.

a. Motor -

Motor NCSs are performed by applying electrical stimulation at various points along the course of a motor nerve while recording the electrical response from an appropriate muscle. Response parameters include amplitude, latency, configuration, and motor conduction velocity.

b. Sensory -

Sensory NCSs are performed by applying electrical stimulation near a nerve and recording the response from a distant site along the nerve. Response parameters include amplitude, latency, and configuration and sensory conduction velocity. 

c. Mixed -

Mixed NCSs are performed by applying electrical stimulation near a nerve containing both motor and sensory fibers (a mixed nerve) and recording from a different location along that nerve that also contains both motor and sensory nerve fibers. Response parameters include amplitude, latency, configuration, and both sensory and motor conduction velocity. 

NCS performed independent of needle EMG may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. When the NCS is used on its own without integrating needle EMG findings or when an individual relies solely on a review of NCS data, the results can be misleading, and important diagnoses may be missed.

In most instances, both NCS and usually EMG are necessary to perform diagnostic testing. While a provider may choose to perform just a NCS, when performed alone it is usually considered to be a screening exam. The only exception to this is a situation when a provider may consider it appropriate to perform a NCS without doing an EMG for the diagnosis of carpal tunnel syndrome with a high pre-test probability.

B. Electromyography
Neurogenic disorders can be distinguishable from myopathic disorders by a carefully performed EMG. For example, both polymyositis and ALS produce manifest weakness. The former carries a very different prognosis and treatment than the latter. An EMG is very valuable in making this distinction. Similarly, classification of nerve trauma into axonal vs. demyelinating categories, with corresponding differences in prognoses, are possible with EMG. Below is a list of common disorders where an EMG, in tandem with a properly conducted NCS, will be helpful in diagnosis:

  1. Nerve compression syndromes, including carpal tunnel syndrome and other focal compressions.
  2. Radiculopathy - cervical, lumbosacral.
  3. Mono/polyneuropathy - metabolic, degenerative, hereditary.
  4. Myopathy - including poly-and dermatomyositis, myotonic and congenital myopathies.
  5. Plexopathy - idiopathic, trauma, infiltration.
  6. Neuromuscular junction disorders - myasthenia gravis. Single fiber EMG is of special value here.
  7. At times, immediately prior to botulinum toxin injection, for localization.
  8. At times, immediately prior to injection of phenol or other substances for nerve blocking or chemodenervation.

There may be other instances, not detailed here, where EMG may be of use.

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.

Limitations:

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. 

Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT) – is not covered by Medicare. 

Electromyography
The necessity and reasonableness of the following uses of EMG studies have not been established:

  • exclusive testing of intrinsic foot muscles in the diagnosis of proximal lesions
  • definitive diagnostic conclusions based on paraspinal EMG in regions bearing scars of past surgeries (e.g., previous laminectomies)
  • pattern-setting limited limb muscle examinations, without paraspinal muscle testing for a diagnosis of radiculopathy
  • EMG testing shortly after trauma, before EMG abnormalities would have reasonably had time to develop
  • surface and macro EMG’s
  • multiple uses of EMG in the same patient at the same location of the same limb for the purpose of optimizing botulinum toxin injections.

For outpatient settings other than Comprehensive Outpatient Rehabilitation Facility (CORF)s, references to "physicians" throughout this policy include non-physicians, such as nurse practitioners, clinical nurse specialists and physician assistants. Such non-physician practitioners, with certain exceptions, may certify, order and establish the plan of care as authorized by State law. (See Sections 1861[s][2] and 1862[a][14] of Title XVIII of the Social Security Act; 42 CFR, Sections 410.74, 410.75, 410.76 and 419.22; 58 FR 18543, April 7, 2000.) Each practitioner must provide only those services within the scope of practice for each state.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

General Information

Associated Information

Documentation Requirements

The patient's medical records must clearly document the medical necessity for the test, including a brief history and exam that ensures the individual(s) that perform/interpret the study do so with adequate knowledge of essential presenting criteria. Data gathered during NCS, however, should be available which reflect the numerical values (latency, amplitude, and nerve conduction), and testing conditions (skin temperature, type of needle, etc.), preferably in a tabular (not narrative) format. The reason for referral and a clear diagnostic impression are required for each study. In cases where a review becomes necessary, a hard copy of waveforms and a complete written report with an interpretation of the test must be submitted upon request. All studies must contain the printed name, signature, and professional designation of ALL individuals, performing, interpreting, and/or supervising the test.

Normal findings and abnormalities uncovered during the study should be documented with the muscles tested, the presence and type of spontaneous activity, as well as the characteristics of the voluntary unit potentials and interpretation.

Sources of Information
N/A
Bibliography
  1. AANEM Position Statement. Proper performance and interpretation of electrodiagnostic studies. Muscle Nerve. 2006;33(3):436-439.
  2. AANEM Position Statement. Recommended Policy for Electrodiagnostic Medicine. Updated 2014
  3. Brown E. An Evidence based technology assessment of the NC-stat® device. 08/21/08. Accessed 6/7/21.
  4. Elkowitz SJ, Dubin NH, Richards BE, Wilgis EF. Clinical utility of portable versus traditional electrodiagnostic testing for diagnosing, evaluating and treating carpal tunnel syndrome. Am J Orthop. 2005;34(8):362-364.
  5. Hilburn JW. General principles and use of electrodiagnostic studies in carpal and cubital tunnel syndromes. With special attention to pitfalls and interpretation. Hand Clin. 1996;12(2):205-221.
  6. Jabre JF, Salzsieder BT, Gnemi KE. Criterion validity of the NC-stat automated nerve conduction measurement instrument. Physiol Meas. 2007;28(1):95-104.
  7. Katz JN, Simmons BP. Clinical Practice. Carpal Tunnel Syndrome. New England Journal of Medicine. 2002;346(23):1807-1812.
  8. Katz RT. NC-stat as a screening tool for carpal tunnel syndrome in industrial workers. J Occup Environ Med. 2006;48(4):414-418.
  9. Kong X, Gozani SN, Hayes MT, Weinberg DH. NC-stat sensory nerve conduction studies in the median and ulnar nerves of symptomatic patients. Clin Neurophysiol. 2006;117(2):405-413.
  10. Leffler CT, Gozani SN, Cros D. Median neuropathy at the wrist: Diagnostic utility of clinical findings and an automated electrodiagnostic device. J Occup Environ Med. 2000;42(4):398-409.
  11. Perkins BA, Grewal J, Ng E, Ngo M, Bril V. Validation of a novel point-of-care nerve conduction device for the detection of diabetic sensorimotor polyneuropathy. Diabetes Care. 2006;29(9):2023-2027.
  12. Vinik AI, Emley MS, Megerian JT, Gozani SN. Median and ulnar nerve conduction measurements in patients with symptoms of diabetic peripheral neuropathy using the NC-stat system. Diabetes Technol Ther. 2004;6(6):816-824.

Revision History Information

Revision History DateRevision History NumberRevision History ExplanationReasons for Change
07/15/2021 R23

Under CMS National Coverage Policy removed Program Memorandum Transmittal B-01-28, Change Request 850, as this has been manualized and is covered in the CMS Internet-Only Manual publication 100-02 listed in this section. Under Bibliography changes were made to citations to reflect AMA citation guidelines. Formatting, punctuation, and typographical errors were corrected, and acronyms were inserted where appropriate throughout the LCD.

  • Provider Education/Guidance
10/10/2019 R22

This LCD is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of this LCD and placed in the related Billing and Coding: Nerve Conduction Studies and Electromyography A56619 article.

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.

  • Provider Education/Guidance
06/13/2019 R21

All coding located in the Coding Information section and all verbiage regarding billing and coding under the Coverage Indications, Limitations and/or Medical Necessity section and the Associated Information section has been removed and is included in the related Billing and Coding: Nerve Conduction Studies and Electromyography A56619 article.

Under CMS National Coverage Policy deleted the regulation “CMS Internet-Only Manual, Pub 100-03, National Coverage Determination Manual, Chapter 1, Part 2, §160.23 Sensory Nerve Conduction Threshold Tests (sNCTs)” from this section. Under Coverage Indications, Limitations and/or Medical Necessity removed all quoted Internet Only Manual (IOM) text and removed italics from verbiage in this section. Formatting, punctuation and typographical errors were corrected throughout the LCD.

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.

  • Provider Education/Guidance
10/01/2018 R20

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes the following ICD-10 codes have been added: G71.09, M79.11, M79.12, M79.18. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes the following ICD-10 codes have been deleted: G71.09, M79.11, M79.12, M79.18.

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.

 

  • Typographical Error
10/01/2018 R19

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes the following ICD-10 codes have been deleted: G51.3, G71.0, M79.1. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes the following ICD-10 codes have been added: G51.31, G51.32, G51.33, G71.00, G71.01, G71.02, I63.81, I63.89, I67.850, I67.858. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes the following ICD-10 codes have been added: G71.09, M79.11, M79.12, M79.18. This revision is due to the Annual ICD-10 Code Update and becomes effective October 1, 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 policy.

 

  • Revisions Due To ICD-10-CM Code Changes
05/10/2018 R18

Punctuation was corrected throughout the policy as necessary.  Acronyms were inserted where appropriate throughout the policy. CPT® was inserted throughout the policy where applicable. Under CMS National Coverage Policy deleted the word “Medicare” in the first cited regulation. A (1) was added after (r) in the second cited regulation. An “a” was added after 42 CFR, Section 410.32 in the fifth cited regulation. The words “Physical Therapists” was added in front of the acronym “PT”, the words “American Board of Physical Therapy Specialties” was added in front of the acronym “ABPTS”, and parentheses were placed around both acronyms in the eighth cited regulation. Under Coverage Indications, Limitations and/or Medical Necessity changed the words “electrodiagnostics (including both NCS and EMG)” to the words “such as nerve conduction studies (NCS) and electromyography (EMG) that are” in the first paragraph.  The word “the” was added in front of the word “American” in the second paragraph. The acronym “AMA” was changed to the words “American Medical Association” in the fourth paragraph. The words “nerve conduction velocity was added in front of the acronym “NCVs” and parentheses were placed around the acronym in the fifth paragraph. Under Coverage Indications, Limitations and/or Medical Necessity – A. Nerve Conduction Studies added the word “the” in the third numbered sentence after the first paragraph.  The word “such” was added after the word “structures” in the fourth paragraph.  The word “such” was added after the word “neuropathies” in the fifth paragraph.  Verbiage was added to subtitle b. Sensory that was inadvertently omitted.  The word “Mixed” was added to subtitle c. and verbiage was added that was inadvertently omitted. Under Coverage Indications, Limitations and/or Medical Necessity – B. Electromyography added the word “a” before the word “properly” in the first paragraph. Under Coverage Indications, Limitations and/or Medical Necessity – Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT) added the words “Internet Only Manual,” before the word “Publication” in the first paragraph. Under Bibliography changes were made to citations to reflect AMA citation guidelines.

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.

  • Provider Education/Guidance
  • Typographical Error
02/26/2018 R17 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 02/25/18. Effective 02/26/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
  • Change in Affiliated Contract Numbers
01/29/2018 R16 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
  • Change in Affiliated Contract Numbers
10/01/2017 R15

Under ICD-10 Codes that Support Medical Necessity Group1: Codes deleted ICD-10 code M48.06. Under ICD-10 Codes That Support Medical Necessity Group 1: Codes added ICD-10 codes G12.23, G12.24, G12.25, M33.03, M33.13, M33.93, M48.061 and M48.062. Under ICD-10 Codes That Support Medical Necessity Group 1:Codes code description changes were made to ICD-10 codes M33.00, M33.01, M33.02, M33.09, M33.10, M33.11, M33.12 and M33.19. This revision is due to the 2017 Annual ICD-10 Code Updates.

 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
05/18/2017 R14 Under CPT/HCPCS Codes – Group 1: Paragraph and Group 2: Paragraph – added verbiage to state “Both a nerve conduction velocity study and an electromyogram must be performed involving the nerve(s) being studied on the same date of service in order to be reimbursed for those procedures. The only exception is in the diagnosis of carpal tunnel which may not in all cases require both a nerve conduction velocity study and an electromyogram”.
  • Provider Education/Guidance
05/11/2017 R13 Under CMS National Coverage Policy - revised title of Title XVIII of the Social Security Act Section 1861(s)(2)(A) to read – ‘Defines medical and other health services’. Revised title of Transmittal B-01-28 Change Request 850 to read, ‘Physician Supervision of Diagnostic Tests’. Revised title of CMS Internet-Only Manual, Publication 100-02 Chapter 15 Section 80 to read ‘Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests’.
Under Coverage Indications, Limitations and/or Medical Necessity- revised sentence from fifth paragraph under A. Nerve Conduction Studies to read “Other instances where knowledge of disease behavior is crucial are Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and Multifocal Motor Neuropathy”. Corrected code listed under Limitations: Nerve Conduction Studies, from 59509 to 95909.
Under Sources of Information and Basis for Decision- grammatical corrections and updates made to sources.
  • Provider Education/Guidance
  • Typographical Error
10/31/2016 R12 Under CPT/HCPCS Codes Group 1: Codes deleted CPT 95873 and under Group 2: Codes deleted CPT code 95874 as these CPT codes are for guidance used for therapeutic procedures and are not diagnostic procedures as per their code descriptions. This revision is retroactive to 10/01/2015.
  • Provider Education/Guidance
  • Other
10/01/2016 R11 Under ICD-10 Codes That Support Medical Necessity added ICD-10 codes G56.03, G56.13, G56.23, G56.33, G56.43, G56.83, G56.93, G57.03, G57.13, G57.23, G57.33, G57.43, G57.53, G57.63, G57.73, G57.83, G57.93, G61.82, M50.020, M50.021, M50.022, M50.023, M50.121, M50.122, and M50.123, deleted ICD-10 codes M50.02, M50.12, M50.22, M50.32, M50.82 and M50.92 and revised the code descriptions for ICD-10 codes S54.8X1A, S54.8X1D, S54.8X1S, S54.8X2A, S54.8X2D and S54.8X2S. This revision is due to the Annual ICD-10 Code Update and becomes effective 10/1/16.
  • Provider Education/Guidance
  • Revisions Due To ICD-10-CM Code Changes
05/19/2016 R10 Under CMS National Coverage Policy corrected the verbiage for Title XVIII of the Social Security Act, §1861(r) and added “indicates” to Title XVIII of the Social Security Act, § 1861(s)(2). Deleted the Federal Register Vol. 62, Number 211. Transmittal 2663, was rescinded and replaced with Transmittal 2677, Change Request 8169, dated March 26, 2013, CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual. Under Coverage Indications, Limitations and/or Medical Necessity A. Nerve Conduction Studies added “to” to the second sentence of the tenth paragraph. Under Sources of Information and Basis for Decision added authors and titles to preexisting references and changed “Washington” to “Wisconsin”. Corrected LCD typographical number error from L31345 to L31346.
  • Provider Education/Guidance
  • Typographical Error
10/01/2015 R9 Under Sources of Information and Basis for Decision removed bibliography Morse J. NC-stat® System, NeuroMetric® Inc. Nerve Conduction Testing System Technology Assessment, as the website www.lni.wa.gov/claimsins/files/omd/tancstat0506.pdf, is longer available for this specific article.
  • Provider Education/Guidance
10/01/2015 R8 Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed.
  • Other (Bill type and/or revenue code removal)
10/01/2015 R7 Under Sources of Information and Basis for Decision updated text hyperlink as the web address had changed for ANNEM Recommended Policy for Electrodiagnostic Medicine.
  • Provider Education/Guidance
10/01/2015 R6 Under Coverage Indications, Limitations and/or Medical Necessity in sentence stating "The diagnosis code 354.0 should be used", removed code 354.0 and put "G56.01 or G56.02" in its place. Under CPT/HCPCS Codes added CPT codes 95872, 95874, 95885, 95886, and 95887 as these codes did not transfer over from the original LCD.
  • Provider Education/Guidance
  • Automated Edits to Enforce Reasonable & Necessary Requirements
10/01/2015 R5 Removed Bill Type 083X, this bill type does not apply to Medicare hospital outpatient claims paid under OPPS. Instead hospitals would use 013X, 014X, or 012X to report Medicare outpatient services.
  • Provider Education/Guidance
10/01/2015 R4 Consolidated LCD into an A/B MAC LCD.
  • Creation of Uniform LCDs Within a MAC Jurisdiction
10/01/2015 R3 Under ICD-10 Codes that Support Medical Necessity the following ICD-10 codes were added: A05.0, A05.2, A05.3, A05.4, A05.5, A05.8, A05.9, A30.0, A30.1, A30.2, A30.3, A30.4, A30.5, A30.8, A30.9, A33, A34, B92, C49.9, D21.9, D48.1, E25.0, E25.8, E74.01, E74.02, E74.03, E74.04, E74.09, F44.4, F44.6, F44.9, F45.42, G04.90, G04.91, G12.1, G12.20, G12.21, G12.22, G12.29, G12.8, G21.0, G21.11, G21.19, G21.2, G21.3, G21.8, G21.9, G23.0, G23.1, G23.2, G23.8, G23.9, G25.0, G25.1, G25.82, G31.9, G31.85, G40.001, G40.009, G40.101, G40.109, G40.111, G40.119, G40.201, G40.209, G40.211, G40.219, G40.301, G40.309, G40.311, G40.319, G40.A01, G40.A09, G40.A11, G40.A19, G40.401, G40.409, G40.411, G40.419, G40.501, G40.509, G40.801, G40.802, G40.803, G40.804, G40.811, G40.812, G40.813, G40.814, G40.821, G40.822, G40.823, G40.824, G40.89, G40.901, G40.909, G40.911, G40.919, G43.001, G43.009, G43.101, G43.109, G43.401, G43.409, G43.501, G43.509, G43.601, G43.609, G43.701 G43.709, G43.A0, G43.B0, G43.C0, G43.D0, G43.801, G43.809, G43.821, G43.829, G43.901, G43.909, G51.1, G52.0, G62.9, G82.20, G90.1, G90.3, G92, G93.0, G93.1, G93.2, G98.8, H50.10, H50.40, H50.50, H55.00, H55.02, H55.03, H55.04, H55.09,H55.81, H55.89, I67.81, I67.82, I67.83, I67.841, I67.848, I67.89, I73.9, I95.0, I95.89, J38.01, M15.3, M19.011, M19.012, M19.021, M19.022, M19.031, M19.032, M19.041, M19.042, M19.071, M19.072, M21.41, M21.42, M25.511, M25.512, M25.521, M25.522, M25.531, M25.532, M25.551, M25.552, M25.561, M25.562, M25.571, M25.572, M25.78, M31.6, M32.10, M43.21, M43.22, M43.23, M43.24, M43.25, M43.26, M43.27, M43.28, M46.48, M46.49, M51.9, M53.2X7, M53.3, M53.84, M53.85, M54.9, M60.000, M60.001, M60.003, M60.004, M65.011, M65.012, M65.021, M65.022, M65.031, M65.032, M65.041, M65.042, M65.051, M65.052, M65.061, M65.062, M65.071, 065.072, M65.08, M65.311, M65.312, M65.321, M65.322, M65.331, M65.332, M65.341, M65.342, M65.351, M65.352, M65.4, M65.811, M65.812, M65.821, M65.822, M65.831, M65.832, M65.841, M65.842, M65.851, M65.852, M65.861, M65.862, M65.871, M65.872, M65.88, M65.89, M71.9, M75.31, M75.32, M75.41, M75.42, M75.81, M75.82,M79.0, M79.89, M93.211, M93.212, M93.221, M93.222, M93.231, M93.232, M93.241, M93.242, M93.251, M93.252, M93.261, M93.262, M93.271, M93.272, M93.28, M93.29, N31.9, N32.81, O26.821, O26.822, O26.823, O90.89, Q07.8,Q68.0, Q76.2, R26.2, R27.9, R29.3, R29.6, R29.810, R29.818, R29.891, R40.0, R40.1, R40.4, R45.83, R45.84, R47.01, R53.2,R55, S04.71XA-S, S04.72XA-S, S24.111A-S, S24.112A-S, S24.113A-S, S24.114A-S, S24.131A-S, S24.132A-S, S24.133A-S, S24.134A-S, S24.141A-S, S24.142A-S, S24.151A-S, S24.152A-S, S64.498A-S, S99.811A-S, S99.812A-S, S99.821A-S, S99.822A-S, and T75.4XXA-S. Under Sources of Information and Basis for Decision removed citation U.S. Food and Drug Administration 510(k) Premarket Notification Database. NeuroMetrix NC-stat.® No. K041320. Rockville, MD: FDA. Aug. 12, 2004 as web site for this particular FDA premarket notification is no longer available.
  • Provider Education/Guidance
  • Automated Edits to Enforce Reasonable & Necessary Requirements
  • Change in Assigned States or Affiliated Contract Numbers
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R2 Under ICD-10 Codes That Support Medical Necessity section of the LCD a descriptor change was made to the following ICD-10 Codes due to the CMS Quarterly Update in June 2014:M50.01, M50.11, M50.21, M50.31, M50.81 and M50.91.
Descriptor changes were made per CMS Quarterly Update in June 2014.
These description changes became effective 7/1/2014.

  • Other (Descriptor changes made per CMS Quarterly Update June 2014.)
10/01/2015 R1 Bill Type Codes and Revenue Codes were added to applicable sections of the LCD. This policy was converted to an A/B MAC LCD and will replace the Part A future draft LCD-DL35183.
  • Creation of Uniform LCDs Within a MAC Jurisdiction

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Keywords

  • EMG
  • NCS

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