Code 95937
Indications and Limitations of Coverage and/or Medical Necessity [/U]
Indications
Neuromuscular junction testing by repetitive stimulation may be reasonable and necessary to diagnose patients with known or suspected disorders of the neuromuscular junction. These include myasthenic syndromes such as myasthenia gravis and Lambert Eaton myasthenic syndrome (LEMS), as well as botulinum toxicity. Rarely, certain drugs such as aminoglycoside antibiotics can potentiate myasthenic symptoms.
Limitations
1. Neuromuscular junction testing by repetitive stimulation is not
considered reasonable necessary for indications other than those
listed above.
2. Neuromuscular junction testing (CPT 95937) must not be billed for any
diagnostic test or procedure that does not meet the CPT definition of
CPT 95937. Examples include quantitative sensory testing by any means
and sensory nerve conduction threshold testing. Tests depending on the
patient's subjective response to stimulation (electrical, vibratory,
thermal or tactile), regardless of whether or not these data are
analyzed and presented through electronic or computerized systems,
also fail to satisfy the definition of CPT 95937.
NOTE: Quantitative Sensory Testing (QST) uses electrical or mechanical
stimuli at varying amplitudes to evoke patients' subjective responses.
Such tests are designed to be helpful in characterizing various types
and degrees of neural damage or impairment. However, the clinical
usefulness of such tests remains unclear. One such device is Current
Perception Threshold/Sensory Nerve Conduction Threshold test
(CPT/sNCT). CMS has determined that this test is not covered since
there is insufficient scientific or clinical evidence to consider this
device as reasonable and necessary within the meaning of
§1862(a)(1)(A) of the Social Security Act. (See Medicare Coverage
Issues Manual 50-57). Another such device is the pressure-specified
sensory device (PSSD), which relies on a pressure stimulus to
determine a sensory threshold. It is not appropriate to bill for QST,
including PSSD, under CPT 95937 or any of the following CPT codes:
95900, 95903, 95904, 95921, 95922, 95923, 95925, 95926, 95927.
3. Neuromuscular junction testing by repetitive stimulation is not
considered reasonable and necessary for the diagnosis or treatment of
diabetic neuropathy.
4. Neuromuscular junction testing by repetitive stimulation is not
considered reasonable and necessary for the diagnosis or treatment of
carpal or tarsal tunnel syndrome.
5. Neuromuscular junction testing by repetitive stimulation is indicated
for specific physical signs and symptoms (e.g. diplopia, weakness,
dysphagia) only if there is actual clinical suspicion that a
neuromuscular junction disorder is the cause.
Coding Guidelines
1. Generally the interpretation or cognitive performance of the test is
considered part of the test and not an E&M service. An E&M service
performed on the same date must be a separate and distinct service &
must be reported with the modifier 25.
2. Use modifier TC when reporting the technical component of 95937. The
technical component is payable in office (11), skilled nursing
facility (SNF) (31) only for patients whose Part A benefits have been
exhausted, and independent clinic (49).
Use modifier 26 when reporting the professional component of 95937.
The professional component is payable in office (11), inpatient
hospital (21), outpatient hospital (22), emergency room (23), skilled
nursing facility (SNF) (31) only for patients whose Part A benefits
have been exhausted, independent clinic (49), comprehensive inpatient
rehabilitation facility (61), comprehensive outpatient rehabilitation
facility (62) and ESRD treatment facility (65).
3. Report code 95937 without a modifier if the global service is being
performed. The global service may be billed in office (11), skilled
nursing facility (SNF) (31) only for patients whose Part A benefits
have been exhausted, or independent clinic (49).
Hope this helps.
Dr. Poonam