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Updates to policies pertaining to nerve conduction studies and needle electromyography

June 30, 2016

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Independence 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 Network Coordinator.

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