Nerve Conduction Velocity Studies

Medical Policy: 02.01.31 
Original Effective Date: January 2007 
Reviewed: August 2011 
Revised: December 2009 

Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.

Description: 

Nerve conduction velocity (NCV) studies are a type of electrodiagnostic study conducted to assess the integrity and function of the peripheral nervous system and to diagnose related diseases. NCV studies measure the velocity of nerve impulses, the amplitude and the wave shapes of the motor responses. Another relevant measurement is that of nerve conduction latency. Abnormal results include slowing of the nerve conduction signal, a completely blocked conduction, failure to elicit a motor response from a nerve signal or a diminished motor response. The results of these tests may assist the physician to arrive at a differential diagnosis based on the degree of demyelination or loss of axon function in various portions of the nerve.

NCV studies are routinely conducted along with needle electromyography (EMG) to enable the clinician to determine the presence and extent of peripheral nerve pathology. EMG studies measure the electrical activity of muscles and their fibers. When used together NCV and EMG allow the clinician to determine if the origin of the pathology is in the proximal or distal portion of the nerve and if neuromuscular dysfunction is related to peripheral nerve disease.

According to the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) “Nerve conduction studies performed independent of needle EMG may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders.” The AANEM points out that when nerve conduction studies are used without integrating needle EMG results, the results can be misleading and important diagnoses can be missed.

The table below is taken from the AANEM’s Recommended Policy for Diagnostic Medicine, updated 2004. AANEM’s recommendations are summarized concerning a reasonable maximum number of studies per diagnostic category necessary for a physician to reach a diagnosis in 90% of patients with that final diagnosis.

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Prior Approval: 

Not applicable

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Policy: 

Nerve conduction velocity studies may be considered medically necessary when conducted and interpreted at the same time as needle electromyography (NEMG) studies, to confirm the diagnosis of ANY of the following medical conditions:

• motor neuron disease
• myopathies
• nerve compression syndromes (e.g. carpal tunnel syndrome)
• neuromuscular junction disorders
• neuropathies
• neurotrauma
• plexopathies
• radiculopathies

Nerve conduction velocity studies when performed alone for any of the above indications may be considered medically necessary in ANY of the following situations:

• current use of anticoagulants
• presence of lymphedema
• carpal tunnel syndrome
• patient cannot tolerate needle electromyography (NEMG) studies
• follow-up studies of neuromuscular structures after undergoing previous electrodiagnostic evaluation consisting of a prior same day NCV study and NEMG.

Nerve conduction studies are considered investigational when:

• performed with automated or hand-held nerve conduction testing or screening devices (e.g. NC-Stat by NeuroMetrix®, Neurometer® and Brevio® NCS-Monitor, XLTEK Neuropath by Excel-Tec, Virtual Medical Systems VT 3000 by Scientific Imaging).
• performed without supervision of a physician.
• the interpretation is delayed and not completed at the time of testing.
• performed without needle electromyography (NEMG) studies and criteria above are not met.

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Procedure Codes and Billing Guidelines: 

• To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9-CM diagnostic codes.
• S3905 Non-invasive electrodiagnostic testing with automatic computerized hand-held device to stimulate and measure neuromuscular signals in diagnosing and evaluating systemic and entrapment neurophathies
• 95885 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary procedure)
• 95886 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, 5 or more muscles studied, innervated by 3 or more nerves or 4 or more spinal levels (List separately in addition to code for primary procedure)
• 95887 Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure)  
• 95900 Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study
• 95903 Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study
• 95904 Nerve conduction, amplitude and latency/velocity study, each nerve; sensory
• 95905 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velcocity study, each limb, includes F-wave study when performed, wth intepretation and report

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Selected References: 

• Wilbourn AJ.  Nerve conduction studies. Types, components, abnormalities, and value in localization. Neurol Clin. 2002 May;20(2):305-38, v.
• Katz RT. NC-stat as a screening tool for carpal tunnel syndrome in industrial workers.  J Occup Environ Med. 2006 Apr;48(4):414-8.
• Kong X, Gozani SN, Hayes MT, Weinberg DH. NC-stat sensory nerve conduction studies in the median and ulnar nerves of symptomatic patients. Clin Neurophysiol. 2006 Feb;117(2):405-13.
• Aminoff MJ. Electrophysiologic testing for the diagnosis of peripheral nerve injuries. Anesthesiology. May 2004;100(5):1298-303.
• David, WS  Literature review: NervePace Digital Electroneurometer in the diagnosis of carpal tunnel syndrome.  Muscle Nerve 2003 Mar;27(3):378-85
• American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Recommended policy for electrodiagnostic medicine. Endorsed by the American Academy of Neurology, The American Academy of Physical Medicine and Rehabilitation and The American Association of Neuromuscular and Electrodiagnostic Medicine. Updated 2004. Available at URL address: http://www.aanem.org/documents/recpolicy.pdf
• American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Proper performance and interpretation of electrodiagnostic studies. Position statement. Approved September 2005. Available at URL address: http://www.aanem.org/documents/ProperPerformance.pdf
• American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Who is qualified to practice electrodiagnostic medicine. Position statement. Approved May 1999. Available at URL address: http://www.aanem.org/documents/who_is_qualified.PDF
• Washington State Department of Labor and Industries. NC-Stat® system, Neurometrix® Inc. Technology Assessment. May 2006. Available at URL address: http://www.lni.wa.gov/ClaimsIns/Files/OMD/taNCSTAT0506.pdf
• Washington State Department of Labor and Industries.  Coverage Decision: NC-Stat conduction Testing System. 06-01 February 2006; 2P. Available at URL address: http://www.lni.wa.gov/ClaimsIns/Files/OMD/taNCSTAT0506.pdf
• American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Proper Performance and Interpretation of Electrodiagnostic Studies. Muscle Nerve. 2006;33(3):436-439. Available at: http://www.aanem.org/documents/ProperPerformance.pdf. Accessed October, 16, 2009.
• ECRI Institute. Point-of-Care Nerve Conduction Tests. Plymouth Meeting (PA): ECRI Institute; 2009 May 18. 11p. [ECRI hotline response.] Also available: http://www.ecri.org. 
• Schmidt K, Chinea NM, Sorenson EJ et al. Accuracy of diagnoses delivered by an automated hand-held nerve conduction device in comparison to standard electrophysiological testing in patients with unilateral leg symptoms. Muscle Nerve 2011; 43(1);9-13.
• England JD, Franklin GM. Automated hand-held nerve conduction devices: raw data, raw interpretations. Muscle Nerve 2011:43(1):6-8.
• ECRI Institute. Point-of-Care Nerve Conduction Tests. Plymouth Meeting (PA): ECRI Institute; 2011 May. Available: http://www.ecri.org.

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Policy History: 

Date                                        Reason                               Action

August 2011                           Annual review                     Policy renewed

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Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

*Current Procedural Terminology © 2010 American Medical Association. All Rights Reserved.