Eli's Rehab Report

Published on Fri Jun 27, 2014 PDF

Question: I’m looking for guidelines regarding who is a qualified healthcare provider for doing an NCS procedure. I have found where EMG/NCS has to be done by a physician or other certified healthcare provider.

Answer: According to CPT® guidelines, “A ‘physician or other qualified health care professional’ is an individual who by education, training, licensure/regulation, and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports a professional service. These professionals are distinct from ‘clinical staff.’ A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service. Other policies may also affect who may report specified services.”

The actual definitions or credentials of professionals who are qualified to report EMG/NCS (nerve conduction study) services may depend on the payer’s limitations as well as state medical scope of practice laws outlining who may report the services.

Also pay attention to Medicare’s indicators for physician supervision of the technical component of EMG or NCS. For example, the technical component of most EMG codes carry the 6A indicator, meaning that the test “May be performed by a physician or by a physical therapist with ABPTS certification and certification in this specific procedure. In addition, the PT with ABPTS certification may supervise another PT, but only the PT with ABPTS certification may bill.” As another example, indicator 7A means “Procedure must be performed by a PT with ABPTS certification or by a PT without certification under direct supervision of a physician, or by a technician with certification under general supervision of a physician; in addition, the PT with ABPTS certification may supervise another PT, but only the PT with ABPTS certification may bill.”