G0255, Current perception threshold/sensory nerve conduction test, (snct) per limb,
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Documentation Required
- The clinical history from the referral source must indicate the need for testing and the medical record must contain pertinent clinical information available for review upon request.
- If an E/M service is separately billable, the medical record must document medical necessity for the separate E/M and the CPT must be billed with modifier 25.
- When testing exceeds the reasonable maximum number of studies listed in the policy table, the physician must provide supplementary documentation justifying the additional testing.
- Documentation must support the medical necessity of testing an asymptomatic contralateral limb when used to establish normative values.
- When repetitive stimulation neuromuscular junction testing (CPT 95937) is performed, the physician's report must document characteristics of the test including the rate of repetition of stimulation and timing of post-exercise or high-frequency stimulus measurements.
- For CPT 95905 use in carpal tunnel patients, the beneficiary's diagnosis must be coded as G56.01, G56.02, or G56.03 and records should support high pre-test probability for carpal tunnel syndrome.
Key Coverage Criteria
- Nerve conduction studies (CPT 95907-95913) and/or needle electromyography (CPT 95860-95864, 95867-95872, 95885-95887) are covered when medically necessary to evaluate Carpal Tunnel Syndrome (unilateral).
- Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate Carpal Tunnel Syndrome (bilateral).
- Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate radiculopathy.
- Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate mononeuropathy.
- Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate polyneuropathy or mononeuropathy multiplex.
- Needle EMG and nerve conduction studies are covered when medically necessary to evaluate myopathy.
19 Active Policies
CGS-L35897, Nerve Conduction Studies and Electromyography
J15
A57478, Billing and Coding: Nerve Conduction Studies and Electromyography
J5
A57668, Billing and Coding: Nerve Conduction Studies and Electromyography
J6
WPS-L34594, Nerve Conduction Studies and Electromyography
J8
NORIDIAN-L36524, Nerve Conduction Studies and Electromyography
JF
PALMETTO-JJ-L35048, Nerve Conduction Studies and Electromyography
JJ
NGS-L35098, Nerve Conduction Studies and Electromyography
JK
PALMETTO-JM-L35048, Nerve Conduction Studies and Electromyography
JM
REGENCE-MED91, Quantitative Sensory Testing
UMR-POL-UMR-neurophysiologic-testing, Neurophysiologic Testing and Monitoring
SUREST-POL-SUREST-neurophysiologic-testing, Neurophysiologic Testing and Monitoring
REGENCE-MED128, Automated Point-of-Care Nerve Conduction Studies
ANTHEM-MED.00092, MED.00092 Automated Nerve Conduction Testing
A54969, Billing and Coding: Nerve Conduction Studies and Electromyography
A56619, Billing and Coding: Nerve Conduction Studies and Electromyography
A57307, Billing and Coding: Nerve Conduction Studies and Electromyography
UHC-POL-neurophysiologic-testing, Neurophysiologic Testing and Monitoring
AETNA-CPB-0357, Quantitative Sensory Testing Methods
ANTHEM-MED.00082, MED.00082 Quantitative Sensory Testing
Related Codes
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