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AmeriHealth has two interrelated medical policies for electrodiagnostic
medicine (nerve conduction studies [NCS] and related electrodiagnostic studies)
and electromyography (EMG) studies (needle EMG, surface EMG [SEMG]). These
policies were developed in accordance with current standards of medical
practice, professional organizations, and criteria presented in Local Medicare
Coverage Determinations.
Effective August 1, 2016, NCS and EMG policies will be updated to
include the addition of applicable diagnosis codes to clarify and support
medically necessary indications. Previously, diagnosis codes were not included.
However, diagnosis codes will be added to help improve the quality of patient
care and to encourage appropriate utilization of the studies involved.
About NCS and needle EMG studies
Electrodiagnostic medicine is an important and useful component of the
clinical evaluation of individuals with disorders of the peripheral and/or
central nervous systems. Both nerve conduction and needle electromyography
studies are often crucial to evaluating symptoms, arriving at a diagnosis, and
evaluating a disease process and response to treatment in individuals with
neuromuscular disorders.
The interrelated medical policies for electrodiagnostic medicine under NCS
and EMG continue to include:
- discussion of NCS studies conducted with needle EMG;
- medically necessary indications;
- statement for the maximum allowable performance of NCS by a non-physician
governed by the scope of practice defined by the state and the appropriate
level of supervision described by the Federal Register;
- credentialing and certification information;
- professional and technical reimbursement;
- recommended guidelines for maximum number of NCS and EMG studies.
Policy updates
In order to communicate the criteria for these tests, we are updating our
commercial and Medicare Advantage policies. The following policies are posted
as Notifications and will become effective August 1, 2016:
- Commercial: #07.03.18j: Nerve Conduction Studies (NCS) and Related
Electrodiagnostic Studies
- Medicare Advantage: #MA07.033a: Nerve Conduction Studies (NCS) and
Related Electrodiagnostic Studies
- Commercial: #07.03.09k: Electromyography (EMG) Studies: Needle EMG,
Surface EMG (SEMG)
- Medicare Advantage: #MA07.050a: Electromyography (EMG) Studies:
Needle EMG, Surface EMG (SEMG)
To view the Notifications for these policies, visit our
Medical Policy
Portal and select
Accept and Go to Medical Policy
Online. Then select either
Commercial or
Medicare Advantage
under Active Notifications.
If you have any questions about these policies, please contact your Provider
Partnership Associate or Network Coordinator.
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