Billing and Coding: Nerve Conduction Studies and Electromyography
A54095
Medicare allows NCS without NEMG for evaluations of carpal or tarsal tunnel when specific ICD-10 codes are reported, and for patients with significant lymphedema or on anticoagulation when the corresponding codes are additionally reported. Several EDX modalities and tests (portable non-waveform devices, psychophysical measurements, wearable physiologic recordings, SEMG/macro-EMG) are non-covered and must be billed as unlisted CPT 95999 with a descriptive entry on the claim; documentation requirements include legible medical records, provider signature, medical necessity, device normal ranges, waveforms/reports on request, and specified per-diagnosis repeat-study limits (generally 2 per 12 months; 3 per 12 months for motor neuron disease and plexopathy).
"Nerve conduction studies (NCS) without needle electromyography (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the diagnosis code..."