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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.28 Evoked Response Tests and Neuromuscular Procedures : Evoked Potential Testing
Evoked potential (EP) tests are a benefit of Texas Medicaid when medically necessary. The most common EP tests are:
Each EP test (procedure codes 92585, 92586, 95925, 95926, 95927, 95928, 95929, 95930, 95938, or 95939) is considered a bilateral procedure and is limited to once per date of service any provider regardless of modifiers that indicate multiple sites were tested.
EP tests may be reimbursed up to four services per rolling year, any combination of services by any provider. Claims that exceed the limitation of four services per rolling year may be considered for reimbursement on appeal with documentation that supports the medical necessity.
Intraoperative neurophysiology monitoring (procedure codes 95940 and 95941) is a benefit when performed in addition to each evoked potential test on the same day.
The documentation for the intraoperative neurophysiology monitoring must include the time for which each test is performed.
Procedure codes 95940 and 95941 are limited to a maximum of two hours per date of service, per client, same procedure, any provider.
Procedure codes 95940 and 95941 must be billed in conjunction with one of the following procedure codes or the service will be denied:
Procedure codes 95940 and 95941 cannot be reported by the surgeon or anesthesiologist.
The reason for the referral, the specific nerve evoked potential being tested, and a clear diagnostic impression must be documented in the client’s medical record for each EP study performed.
The client’s medical records must clearly document the medical necessity for the EP testing. The medical record documentation must reflect the actual results of specific tests (such as latency and amplitude).
Medical necessity for re-evaluation of a client (beyond the initial consultation and testing) must be clearly documented in the client’s medical record. Supporting documentation includes, but is not limited to, the following:
The client’s medical records are subject to retrospective review. Wave form recordings obtained during the testing will aid documentation requirements in cases where a review becomes necessary.
Some of the conditions under which VEP testing (procedure code 95930) may be appropriate include, but are not limited to, the following:

Texas Medicaid & Healthcare Partnership
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