We are getting denials for NCS's from Medicare stating "service denied based on LCD, but all of the dx codes we use are on the current LCD list as covered. Are we missing something? Does MDCR not pay for codes 95907-95913? Any info would be greatly appreciated!!! Thanks
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Wiki Nerve conduction studies
- Thread starter tashajoy
- Start date
BShepherd626
New
Generally a neurologist or physical medicine provider would possess the necessary accreditation that is recognized by Medicare to render the service. I copied this from Novitas Solutions LCD L29587 for Jurisdiction L:
"Guidelines about proper qualifications for qualified health care professionals performing electrodiagnostic evaluations have been developed and published by AANEM (American Association of Neuromuscular and Electrodiagnostic Medicine) and other medical organizations, including the AMA, the American Academy of Neurology, the American Academy of Physical Medicine and Rehabilitation, American Neurological Association, the American Board of Physical Therapy Specialties (ABPTS) in Clinical Electrophysiology, and the Department of Veterans Affairs.
Novitas Solutions, Inc expects healthcare professionals who perform electrodiagnostic (ED) testing will be appropriately trained and/or credentialed, either by a formal residency/fellowship program, certification by a nationally recognized organization or by an accredited post-graduate training course covering anatomy, neurophysiology and forms of electrodiagnostics (including both NCS and EMG) 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 and Rehabilitation physicians."
"Guidelines about proper qualifications for qualified health care professionals performing electrodiagnostic evaluations have been developed and published by AANEM (American Association of Neuromuscular and Electrodiagnostic Medicine) and other medical organizations, including the AMA, the American Academy of Neurology, the American Academy of Physical Medicine and Rehabilitation, American Neurological Association, the American Board of Physical Therapy Specialties (ABPTS) in Clinical Electrophysiology, and the Department of Veterans Affairs.
Novitas Solutions, Inc expects healthcare professionals who perform electrodiagnostic (ED) testing will be appropriately trained and/or credentialed, either by a formal residency/fellowship program, certification by a nationally recognized organization or by an accredited post-graduate training course covering anatomy, neurophysiology and forms of electrodiagnostics (including both NCS and EMG) 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 and Rehabilitation physicians."
dclark7
True Blue
There ismore to the LCD than diagnosis codes. You must meet all of the requirements shown in the LCD for claims to be covered. Re-read the LCD and see what lese besides the diagnosis could be the problem
JacquelineWilson
Guest
Nerve Conduction Studies
I realize that this post is rather old, but just in case anyone searches for this again, in my experience: In order for a Nerve Conduction Study to be considered, a needle EMG (95885, 95886) must also be performed in order for the testing to be considered "complete." When it comes to LCD, yes there are qualifying guidelines for medical necessity, but the only ones I've seen paid without a needle EMG are with a Dx of Carpal Tunnel Syndrome. Otherwise, they almost always deny for medical necessity and as "experimental."
I hope this helps!
I realize that this post is rather old, but just in case anyone searches for this again, in my experience: In order for a Nerve Conduction Study to be considered, a needle EMG (95885, 95886) must also be performed in order for the testing to be considered "complete." When it comes to LCD, yes there are qualifying guidelines for medical necessity, but the only ones I've seen paid without a needle EMG are with a Dx of Carpal Tunnel Syndrome. Otherwise, they almost always deny for medical necessity and as "experimental."
I hope this helps!