Medical Policy: 02.01.31
Original Effective Date: January 2007
Reviewed: March 2016
Revised: March 2016
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.
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.
Automated Point of Care Nerve Conduction Tests
Studies have shown the correlation of portable automated nerve conduction test results with standard testing; however, questions remain about the diagnostic performance and clinical utility (i.e., impact on outcomes) of point-of-care automated testing. Particularly needed are data on the sensitivity and specificity of automated nerve conduction tests performed by non-specialists at the point-of-care in comparison with the "gold standard" of laboratory NCS/EMG. One study from a tertiary care clinic found high sensitivity but low specificity for the diagnosis of lumbosacral radiculopathy. Another potential clinical use could be early identification of asymptomatic diabetic neuropathy to institute-appropriate clinical management before the onset of ulcerations, but no studies were identified that assessed the influence of point-of-care nerve conduction tests on clinical outcomes in this population. Overall, evidence addressing the utility of point-of-care automated nerve conduction tests in a clinical setting is limited. There is no peer-reviewed published medical literature on the use of voltage-actuated sensory nerve conduction tests and their impact on clinical outcomes. Overall, evidence remains insufficient to evaluate the effect of automated point-of-care nerve conduction tests on health outcomes. Therefore, automated point-of-care nerve conduction tests are considered investigational.
In a position statement on the Proper Performance and Interpretation of Electrodiagnostic Studies and the Recommended Use of Electrodiagnostic Medicine from the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM, 2014), although no specific reference to or recommendation for automated nerve conduction testing devices is made, it is noted that "Nerve conduction studies performed independent of needle EMG studies may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders."
Individuals without a medical education in neuromuscular disorders and without special training in EDX procedures typically are not qualified to interpret the waveforms generated by NCSs and needle EMGs or to correlate the findings with other clinical information to reach a diagnosis.
Nerve conduction studies (NCV) are considered investigational when:
- performed with automated or hand-held nerve conduction testing or screening devices (e.g. ADVANCE, 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.
Nerve conduction studies (NVC) are considered investigational for screening for all diagnosis, including but not limited to: polyneuropathy of diabetes or end-stage renal disease.
Although portable, automated, noninvasive testing of nerve conduction has been suggested as an easier method for providers to obtain rapid results, the AANEM recommends that electrodiagnostic studies of EMG and NCS be performed together, except in unique situations, in a study design determined and interpreted by a trained physician, so that healthcare decisions are based on complete diagnostic information (AANEM, 2004). Currently, there is insufficient evidence in the published data to demonstrate that the use of automated nerve conduction testing devices are valid measures in the diagnosis of peripheral nerve disease.
Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.
- 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.
- 95999 Unlisted neurological or neuromuscular diagnostic procedure
- American Association of Neuromuscular and Electrodiagnostic Medicine (AANEMExternal Site). 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 2014.
- Washington State Department of Labor and Industries. NC-Stat® system, Neurometrix® Inc. Technology AssessmentExternal Site. May 2006.
- Washington State Department of Labor and Industries. Coverage Decision: NC-Stat conduction Testing SystemExternal Site. 06-01 February 2006; 2P. ECRI InstituteExternal Site. Point-of-Care Nerve Conduction Tests. Plymouth Meeting (PA): ECRI Institute; 2009 May 18. 11p. [ECRI hotline response.]
- 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 InstituteExternal Site; 2011 May.
April 2016 - Annual Review, Policy Revised
April 2015 - Annual Review, Policy Revised
April 2014 - Annual Review, Policy Renewed
June 2013 - Annual Review, Policy Revised
July 2012 - Annual Review, Policy Renewed
August 2011 - Annual Review, Policy Renewed
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 © 2012 American Medical Association. All Rights Reserved.