NCV denials from Medicare

[lorrieb23]

We are seeing an increased number of denials from Medicare for NCV testing (95911-95913) when billed alone (without the EMG). The denials state 'not deemed a medical necessity'. Dx codes used are included in the LCD. Anyone else having this problem?

 

[mhstrauss]

We are seeing an increased number of denials from Medicare for NCV testing (95911-95913) when billed alone (without the EMG). The denials state 'not deemed a medical necessity'. Dx codes used are included in the LCD. Anyone else having this problem?

What are some of the dx being used, and who is your MAC?

 

[JenKozicki]

same issue

I am having the same problem. We are in Maryland

 

[vsdambrogi@aol.com]

same issue with medicare denials and ncv/emg

I am in Md also and having same issue. If you figure it out someone please post. Is it Medicare? Has anyone called Medicare and asked? Just curious.

 

[marvelh]

Check your Medicare coverage policy as many of the LCD limit NCS testing alone (no EMG performed) to only for carpal tunnel syndrome. For example, the following is an excerpt from the Novitas LCD:

In most instances, both NCS and EMG are necessary to perform diagnostic testing. While a provider may choose to perform just a NCS, when performed alone it will be considered to be a screening exam. The only exception to this is a situation where 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 that has yet to be confirmed.​

 

[knbiggs]

Im in oklahoma, same here! We only do NCS alone when the patient is on a bloodthinner.. i had to appeal these and state that is why.

95909 with modifer KX and the model number of machine used on the claim. this is an example of how we bill...