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. When performed for other conditions, NCV studies are considered not medically necessary. A participating, preferred or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

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.

Non-invasive electrodiagnostic testing with an automated computerized hand-held device (95905)(e.g., NC-stat®) to stimulate and measure neuromuscular signals is considered experimental/investigational in the diagnosis and evaluation of systemic and entrapment neuropathies. Scientific evidence does not show that motor and/or sensory nerve conduction using preconfigured electrode arrays (such as testing like that done with the NC-stat® device) is equivalent to traditional nerve conduction study methods. Automated, non-invasive nerve conduction testing is therefore not covered and is not eligible for payment. A participating, preferred, or network provider can bill the member for this non-covered service. 

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.

This medical policy may not apply to FEP. Medical Policy is not an authorization, certification, explanation of benefits or a contract. Benefits are determined by the Federal Employee Program.

National Blue Cross Blue Shield Association Medical Policy 2.01.77, Automated Point-of-Care Nerve Conduction tests

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review, The Journal of Orthopedic and Sports Physical Therapy, Volume 34, Number 10, 10/2004

Median and Ulnar Nerve Conduction Measurement in Patients with Symptoms of Diabetic Peripheral Neuropathy Using the NC-Stat System, Diabetes Technology & Therapeutics, Volume 6, Number 6, 12/2004

Clinical Utility of Portable Versus Traditional Electrodiagnostic Testing for Diagnosing, Evaluating, and Treating Carpal Tunnel Syndrome, American Journal of Orthopedics, Volume34, Number 8, 08/2005

Proper Performance and Interpretation of Electrodiagnostic Studies, American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), Muscle & Nerve, Volume 33, Number 3, 2006.

NC-Stat Sensory Nerve Conduction Studies in the Median and Ulnar Nerves of Symptomatic Patients, Clinical Neurophysiology: official journal of the International Federation of Clinical Neurophysiology, Volume 117, Number 2, 02/2006

NC-Stat as a Screening Tool for Carpal Tunnel Syndrome in Industrial Workers, The Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine, Volume 48, Number 8, 04/2006

Validation of a Novel Point-of-Care Nerve Conduction Device for the Detection of Diabetic Sensorimotor Polyneuropathy, Diabetes Care, Volume 29, Number 9, 09/2006

Diabetic Nerve Conduction Abnormalities in the Primary Care Setting, Diabetes Technology & Therapeutics, Volume 8, Number 6, 12/2006

Repeatability of Nerve Conduction Measurements Using Automation, Journal of Clinical Monitoring and Computing, Volume 20, Number 6, 12/2006

Criterion Validity of the NC-Stat Automated Nerve Conduction Measurement Instrument, Physiological Measurement, Volume 28, Number 1, 01/2007

Utility of Nerve Conduction Studies for Carpal Tunnel Syndrome by Family Medicine, Primary Care, and Internal Medicine Physicians, Journal of the American Board of Family Medicine, Volume 20, Number 1, 01-02/2007

Fisher MA, Bajwa R, Somashekar KN. Lumbosacral radiculopathies—the importance of EDX information other than needle electromyography. Electromyogr Clin Neurophysiol. 2007;47(7-8):377-84.

Lesser EA, Starr J, Kong X, et al. Point-of-service nerve conduction studies: an example of industry driven disruptive innovation in health care. Perspec Biol Med. 2007;50(1):40-53.

Armstrong TN, Dale AM, Muhammad T, et al. Median and ulnar nerve conduction studies at the wrist: criterion validity of the NC-stat automated device. Journal of Occupational and Environmental Medicine. 2008;50(7):758-64.

Perkins BA, Orszag A, Grewal J, et al. Multi-Site testing with a point-of-care nerve conduction device can be used in an algorithm to diagnose diabetic sensorimotor polyneuropathy. Diabetes Care. 2008;31(3):522-4.

Keith MW, Masear V, Chung K, et al. Diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009;17(6):389-96.