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Coverage criteria policies

Nerve Conduction Studies (using automated devices)

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not applicable for nerve conduction studies using automated devices because it is considered investigational/experimental.

The provider and facility will be liable for payment unless:

  • The provider notifies the member that a specific service has been determined by HealthPartners to be investigational/experimental; and
  • The member signs a waiver agreeing to pay for the specific non-covered service being rendered; and
  • The claim has been billed with a GA modifier indicating such. If the member has signed a waiver agreeing to pay for the specific service then the member will be liable for payment.

Coverage

Please Note: This policy does not address standard electromyography (EMG). Standard EMGs are covered without prior authorization.

Nerve conduction studies using portable automated devices are considered investigational/experimental and are therefore not covered.

Definitions

Nerve conduction studies are performed to evaluate and document a diagnosis of neuropathy and conditions involving sensory nerve dysfunction. Both automated and standard nerve conduction studies involve electrical stimulation of peripheral nerves and the resulting electrical responses.

Automated nerve conduction studies using portable devices can be performed in the primary care setting. The NC-stat system developed by NeuroMetrix, Inc., the Neural-Scan, and the Brevio NCS monitor are examples of this type of technology.

Standard nerve conduction studies (not addressed in this policy) are usually performed in conjunction with invasive needle electromyography (EMG) testing, and are done at a neurological testing facility.

If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all inclusive.

Codes

Description

95905

Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report

S3905

Noninvasive electrodiagnostic testing with automatic computerized hand-held device to stimulate and measure neuromuscular signals in diagnosing and evaluating systemic and entrapment neuropathies

CPT Copyright American Medical Association. All rights reserved.  CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. AANEM Position Statement. American Association of Neuromuscular & Electrodiagnostic Medicine. Muscle Nerve 33: 436–439, 2006.
  2. American Association of Neuromuscular & Electrodiagnostic Medicine. Recommended Policy for Electrodiagnostic Medicine. www.aanem.org. Last accessed July 2016.
  3. Hayes, Inc. (2007). Nc-stat® System (NeuroMetrix Inc.) for Noninvasive Nerve Conduction Testing of Upper Extremity Neuropathy. Philadelphia, PA: Hayes, Inc.

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Policy activity

  • 02/07/2005 - Date of origin
  • 02/07/2005 - Effective date
Review date
  • 09/2016

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