95941 is the reader code for anyone under the age of 65. If you are billing for anyone over the age of 65 or disabled and has Medicare replacement policy, use G0453 for reader code. 95937 is the train of four code and this code is rarely paid because it is no longer a valid code and there is not a good code for train of four, so do not waste your time appealing for this denial. I never put a modifier 59 on train of four code. 95861 is for 5 or more muscle groups, you have to know how many muscle the tech reported; use 95870 for 4 or less muscle groups. If the tech is doing nerve conduction or pedicle screw testing, the EMG code would be 95885 (4 or less muscles) or 95886 (5 or more muscle), as well as the nerve conduction code 95907-95913. You cannot bill 95885 or 95886 without 95907-95913.
UHC, UMR, Golden Rule, Global Health require the reader code G0453 no matter the age of patient.
Cigna CCI edits say they will not pay for EMG/tests with a reader code, so we do not bill the reader code and having success.
Aetna requires the claim to be billed for professional only (do not separate pro and tech claim). No modifier on reader code, and a 26 modifier on all other codes except supplies.
UMR requires a modifier 59 on reader code and a 26 on all other codes except supplies, professional claim only, do not separate pro and tech claims.
BCBS is its own beast! Each state is different on how BCBS wants IONM billed. I do know that BCBS MO requires a 26 modifier on all codes except reader and supplies; BCBS TX no modifiers; BCBS CO modifier 26 on all codes except reader and supplies and they want a taxonomy code; BCBS CA 26 modifier on all codes except reader and supplies. All BCBS should be billed professional claim only, do not bill pro and tech claims.
Hope this helps. Let me know if you have any other specific questions.
