CSHCN 2009 >29.2.17.2 Limitations

Any electrodiagnostic testing procedures may be reimbursed up to 4 distinct dates of service per calendar year by the same provider.

Any E/M service will be denied as part of another service when billed for the same date of service as EMG or NCS service by the same provider.

NCS are limited to the following number of studies per date of service, by the same provider:


NCS Procedure Codes	Studies Allowed per Date of Service	NCS Procedure Codes	Studies Allowed per Date of Service
95900	5	95903	5
95904	6	95930	1
95933	2	95934	2
95936	2	95937	3

When the same studies are performed on unique sites by the same provider for the same date of service, studies for the first site must be billed without a modifier and studies for each additional site must be billed with modifier 59.

Procedure codes 95900, 95903, 95904, 95934, and 95936 may be reimbursed at full fee for the first study and half for each additional study, irrespective of the number of studies.

Procedure codes 95900, 95903, and 95904 may be reimbursed only once when multiple sites on the same nerve are stimulated or recorded.

Procedure code 95934 or 95936 may be reimbursed at full fee when performed with procedure code 95900, 5903, or 95904.

Procedure codes 95900 and 95920 will be denied if billed with procedure code 95903 by the same provider for the same date of service.

The following procedure codes may be reimbursed for one service per day for each procedure by the same provider:


Procedure Codes
51784	51785	95860	95861	95863
95864	95865	95866	95867	95868
95869	95870	95872	95873	95874
95875

Procedure code 95870 may be reimbursed in multiple quantities if specific muscles are documented.

Procedure code 95860 will be denied as part of another service when billed for the same date of service by the same provider as procedure code 95861, 95863, or 95864.

Procedure code 95861 will be denied as part of another service when billed for the same date of service by the same provider as procedure code 95863 or 95864.

Procedure code 95863 will be denied as part of another service when billed for the same date of service by the same provider as procedure code 95864.

Procedure code 95867 will be denied as part of another service when billed for the same date of service by the same provider as procedure code 95868.

Procedure codes 36000 and 36410 will be denied as part of another service when billed for the same date of service by the same provider as procedure code 95875.