Billing and Coding: Nerve Conduction Studies and Electromyography
A54969
Medicare covers nerve conduction studies (CPT 95907-95913), needle electromyography (CPT 95860-95872, 95885-95887), and neuromuscular junction testing (CPT 95937) when medically necessary for specified diagnostic categories (e.g., carpal tunnel, radiculopathy, mononeuropathy, polyneuropathy, myopathy, motor neuronopathy, plexopathy, NMJ disorders, tarsal tunnel, focal/generalized weakness, and focal/bilateral sensory complaints). The policy provides reasonable maximum numbers of studies per diagnostic category (see table) and requires documentation of clinical history, justification for tests exceeding the maxima, and specific test reporting (e.g., stimulation rates for CPT 95937); CPT 95905 is limited to one service per limb and only for ICD-10 G56.01–G56.03, while G0255 (sNCT) is noncovered. Physical therapist performance and billing are restricted by MPFSDB supervision level designations and ABPTS certification status, and separate E/M services require distinct documentation and modifier 25.