Billing & Payments

Billing of electrodiagnostic medicine codes must be in accordance with CPT® code definitions and supervision levels. Billing of the technical and professional portions of the codes may be separated. However, the physician billing for interpretation and diagnosis (professional component) must have direct contact with the patient at the time of testing.

Physical therapists (PTs) who meet the requirements of Department of Health rules (WAC 246-915-370) may provide electroneuromyographic tests. PTs performing electrodiagnostic testing must provide documentation of proper DOH licensure to L&I Provider Accounts prior to performing and billing for these services. PT providers may bill for the technical and professional portion of the nerve conduction and electromyography tests performed. Please contact L&I Provider Accounts at (360) 902-5140 for information on where to send proper license documentation.

Performance and billing of NCS (including SSEP and H-reflex testing) and EMG that consistently falls outside of the AANEM recommended number of tests (see Table) may be reviewed for quality and ‘proper and necessary’.

The department may recoup payments made to a provider, plus interest, for NCS and EMG tests paid inappropriately.

The table below was developed by the AANEM and summarizes reasonable limits on units required, per diagnostic category, to determine a diagnosis 90% of the time. Review of the quality and appropriateness (proper and necessary) may occur when testing repeatedly exceeds AANEM recommendations.

Recommended Maximum Number of Studies by Indication (adapted from AANEM Table 1).

  Needle EMG
CPT® 95860-95864, 95867-95870
NCS
CPT® 95907-95913
Other EMG studies
CPT® 95934, 95936, 95937
 
Indication # of tests Motor NCS with and without F-wave Sensory NCS H-Reflex Neuromuscular Junction Testing (repetitive stimulation)
Carpal tunnel (unilateral) 1 3 4    
Carpal tunnel (bilateral) 2 4 6    
Radiculopathy 2 3 2 2  
Mononeuropathy 1 3 3 2  
Poly/mononeuropathy multiplex 3 4 4 2  
Myopathy 2 2 2   2
Motor neuronopathy (eg, ALS) 4 4 2   2
Plexopathy 2 4 6 2  
Neuromuscular Junction 2 2 2   3
Tarsal tunnel (unilateral) 1 4 4    
Tarsal tunnel (bilateral) 2 5 6    
Weakness, fatigue, cramps, or twitching (focal) 2 3 4   2
Weakness, fatigue, cramps, or twitching (general) 4 4 4   2
Pain, numbness or tingling (unilateral) 1 3 4 2  
Pain, numbness or tingling (bilateral) 2 4 6 2  

*Table recreated with written permission from the AANEM.

Internet access to AANEM recommendations:

http://www.aanem.org/Practice/Position-Statements.aspx