Nerve conduction velocity (NCV) studies may be indicated for the following conditions:

1. Focal neuropathies or compressive lesions, for localization.
2. Traumatic nerve lesions, for diagnosis and prognosis.
3. Diagnosis or confirmation of suspected generalized neuropathies, such as diabetic, uremic, metabolic, or immune.
4. Repetitive nerve stimulation in diagnosis of neuromuscular junction disorders such as myasthenia gravis, myasthenic syndrome.
5. Differential diagnosis of symptom-based complaints (e.g., pain in limb, weakness, disturbance in skin sensation or paresthesia) provided the clinical assessment supports the need for a study.

NCV studies are eligible for reimbursement when performed for any of the indications listed in the Text Attachment below.

An F-Wave (95903) is considered a form of nerve conduction testing. When reported independently, it should be processed according to the number of nerves studied.

H-reflex testing (95934, 95936) can be paid separately from the NCV studies listed under procedure codes 95900-95904. Payment should be limited to one unilateral or bilateral study per session per code.

Neuromuscular junction testing (repetitive stimulation) should be processed separately under procedure code 95937. Payment should be limited to two repetitive stimulations per session.

Payment higher than the established allowance for an NCV study (95900-95904) should not be made if a doctor reports that multiple methods (e.g., surface and needle electrodes) or multiple sites were used, or that an anatomical crossover existed (e.g., a median nerve is stimulated but the ulnar nerve is affected). None of these constitute a circumstance of such an unusual nature as to warrant additional payment.

NOTE:

Refer to Medical Policy Bulletin M-28 for information on Electromyography (EMG).

Description

A nerve conduction velocity study aids in diagnosing peripheral nerve injuries and diseases affecting the peripheral nervous system. To measure nerve conduction time, a nerve is stimulated electronically through the skin and underlying tissue.

Results of NCV studies reflect on the integrity and function of the myelin sheath (covering of a nerve fiber) and the axon (an impulse conducting extension neurons) of the nerve. Damage or destruction of the axon usually results in loss of nerve or muscle amplitude potential. Demyelination (damage or destruction of the myelin sheath) leads to prolongation of nerve conduction time.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

PRN References

02/1993, H-Reflex test, reimbursement for
04/2002, HIPPA regulations eliminate EMG and NCV combination codes