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Requirements for appropriate electrodiagnostic testing

• EMG and NCS should be performed by or under the direct, in office, supervision of a neurologist or physical medicine and rehabilitation specialist (physiatrist). Direct supervision is defined by Centers for Medicare and Medicaid Services (CMS) to mean the physician is present in the office suite when the test is performed.ⁱ The physician interpreting EMG and NCS results should be formally trained in neurology, or physical medicine and rehabilitation.
  • Exception: Per Washington State law, physical therapists who meet the requirements of Department of Health (DOH) rule (WAC 246-915-370) may perform EMG and NCS upon referral by an authorized healthcare practitioner (RCW 18.74.010(7)). The authorized practitioner must be the Attending Provider on the injured worker's claim, a consultant, or a provider authorized by the insurer to provide concurrent care on the claim.
• Interpretation and diagnosis of EMG and NCS results requires face-to-face contact with the patient.
• Diagnosis, based on results of EMG or NCS for the purposes of Washington State Workers’ Compensation claims, must be made by the neurologist or physiatrist, or by the Attending Provider, a consultant, or a provider authorized by the insurer to provide concurrent care on the claim.
• Technicians may perform NCS under the direct, in office, supervision of a neurologist or physiatrist.
• EMG and NCS testing for suspected carpal tunnel syndrome is addressed in the department’s Medical Treatment Guidelines for Carpal Tunnel Syndrome available at: http://www.LNI.wa.gov/ClaimsIns/Providers/Treatment/TreatGuide/Default.asp

Non-covered electrodiagnostic testing services

1. Testing which is not Proper and Necessary per WAC 296-20-01002.
   In general, repetitive testing is not considered Proper and Necessary except:
   i. To document ongoing nerve injury, for example, following surgery.
   ii. If required for provision of an impairment rating.
   iii. To document significant changes in clinical condition.
2. Testing by mobile diagnostic labs, in which the specialist physician is not present to examine and test the patient.
3. Testing with non-covered devices including portable, automated and ‘virtual’ devices not demonstrated equivalent to traditional lab-based equipment (eg, NC-stat®, Brevio).
4. Testing determined to be outside of AANEM recommended guidelines without proper documentation supporting that it is proper and necessary. For access to complete AANEM recommendations please follow links at the bottom of the Billing & Limitations page.

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