Effective for dates of service on or after January 1, 2023, evoked response test and neuromuscular procedure benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program.
Overview of Benefit Changes
Major changes to this medical benefit include the following:
- Updates for some electromyography (EMG) and nerve conduction study (NCS) limitations
- Prior authorization updates for motion analysis (MA) and NCS
- Procedure code updates
- Updated list of payable diagnosis codes for EMG and NCS procedure codes
Limitation Updates
Limitations for the following EMG procedure codes will change as follows:
Procedure Codes |
New Limitations |
95866 |
One service per day, by the same provider |
95872, 95875 |
Two services per day, by the same provider |
NCS procedure codes 95885 and 95886 will be limited to once per extremity up to two units, using any combination of procedure codes, per day, any provider.
Prior Authorization Updates
The CSHCN Services Program Request for Authorization and the Prior Authorization Request Form must be signed by the requesting provider on or within 90 days before the requested start of service. All dates of service prior to the submission of the CSHCN Services Program Request for Authorization and the Prior Authorization Request Form will be denied.
MA Studies
MA is most often used as a diagnostic tool for persons with neuromuscular conditions, primarily as part of the surgical decision-making process when all conservative measures have been exhausted and surgical intervention is being considered. MA study procedure codes 96000, 96001, 96002, and 96003 will no longer require prior authorization for persons who have a diagnosis of cerebral palsy, traumatic brain injury, myelomeningocele, or stroke.
Prior authorization requests for a diagnosis other than cerebral palsy, traumatic brain injury, myelomeningocele, or stroke, or for more than two services per year, will be considered with medical necessity on a case-by-case basis upon review by the CSHCN Services Program medical director or designee.
Prior authorization requests for MA studies must include documentation with the following information, indicating that the person meets all the requirements for MA studies:
- The person is ambulatory for a minimum of ten consecutive steps, with or without assistive devices.
- The person is 3 years through 20 years of age.
- The person is physically able to tolerate up to three hours of testing.
- There is clear documentation that the study is being performed as part of a preoperative or postoperative assessment based on the surgical plan of the person.
NCSs
Procedure code 95937 is limited to three studies per day, same provider. Prior authorization is required for more than three studies per day. Documentation must be submitted to establish medical necessity for the additional studies, including one or more of the following:
- Additional diagnoses to be considered
- Clinical signs, symptoms, or electrodiagnostic findings that necessitate the consideration of the additional diagnosis
Procedure Code Updates
Payable provider types and places of service will be updated for several procedure codes.
Note: For the purposes of the following subsections, “advanced practice registered nurse (APRN)” includes nurse practitioner and clinical nurse specialist providers only.
Unlisted procedure code 95999 will be updated to add physician providers for services rendered in the inpatient hospital setting.
Autonomic Function Tests
Procedure codes 95922 and 95923 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
No changes |
Physician providers will be added. |
No changes |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
Not applicable (N/A) |
No changes |
Procedure code 95921 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
No changes |
Physician providers will be added; hospital providers will be removed. |
Portable x-ray supplier, radiological lab, and physiological lab providers will be removed. |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
No changes |
EMG
Procedure codes 51784 and 51785 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
Portable x-ray supplier, radiological lab, and physiological lab providers will be removed. |
Physician providers will be added. |
Physician providers will be added; hospital providers will be removed. |
Professional |
No changes |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
No changes |
Procedure codes 95860, 95861, 95863, and 95864 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
No changes |
N/A |
Portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
No changes |
Procedure codes 95865 and 95866 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
No changes |
N/A |
Portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
Professional |
APRN providers will be added. |
No changes |
Portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
Technical |
APRN providers will be added. |
N/A |
Services will no longer be a benefit in this setting. |
Procedure codes 95867, 95868, 95869, 95872, and 95875 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
No changes |
N/A |
Portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
Professional |
APRN providers will be added. |
No changes |
Portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
Technical |
APRN providers will be added. |
N/A |
No changes |
Procedure code 95870 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
No changes |
N/A |
Radiation therapy center, portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
Professional |
APRN providers will be added. |
No changes |
Portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
Technical |
APRN providers will be added. |
N/A |
No changes |
NCSs
Procedure codes 95885, 95886, and 95887 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN and radiation therapy center providers will be added. |
N/A |
Radiation therapy center providers will be added. |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
No changes |
Procedure code 95905 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN providers will be added. |
N/A |
No changes |
Professional |
No changes |
No changes |
No changes |
Technical |
Physician and radiation therapy center providers will be removed. |
N/A |
Services will no longer be a benefit in this setting. |
Procedure codes 95907, 95908, 95909, 95910, 95911, 95912, and 95913 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
No changes |
N/A |
No changes |
Professional |
No changes |
No changes |
No changes |
Technical |
Portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
N/A |
N/A |
Procedure code 95933 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN and radiation therapy center providers will be added. |
APRN and physician providers will be added. |
APRN, physician, optometrist, radiation therapy center, portable x-ray supplier, radiological lab, and physiological lab providers will be added; hospital providers will be removed. |
Professional |
APRN providers will be added. |
APRN providers will be added. |
APRN providers will be added. |
Technical |
APRN providers will be added. |
N/A |
APRN, physician, optometrist, federally qualified health center (FQHC), portable x-ray supplier, radiological lab, and physiological lab providers will be added; hospital providers will be removed. |
Procedure code 95937 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
No changes |
Physician providers will be added. |
No changes |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
No changes |
Motor Evoked Potentials
Procedure codes 95928 and 95929 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN providers will be added. |
Physician providers will be added. |
No changes |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
No changes |
Procedure code 95939 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN and radiation therapy center providers will be added. |
N/A |
Radiation therapy center providers will be added. |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN and radiation therapy center providers will be added. |
N/A |
No changes |
Somatosensory Evoked Potentials
Procedure code 95925 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN providers will be added. |
Physician providers will be added. |
No changes |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
Portable x-ray supplier, radiological lab, and physiological lab providers will be added; radiation therapy center providers will be removed. |
Procedure codes 95926 and 95927 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN providers will be added. |
Physician providers will be added. |
No changes |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
No changes |
Procedure code 95938 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN and radiation therapy center providers will be added. |
N/A |
Radiation therapy center providers will be added. |
Professional |
APRN providers will be added. |
No changes |
No changes |
Technical |
APRN providers will be added. |
N/A |
Radiation therapy center providers will be added. |
Visual Evoked Potential
Procedure code 95930 will be updated as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
APRN and radiation therapy center providers will be added. |
APRN and physician providers will be added. |
APRN, physician, optometrist, radiation therapy center, portable x-ray supplier, radiological lab, and physiological lab providers will be added; hospital providers will be removed. |
Professional |
APRN providers will be added. |
APRN providers will be added. |
APRN providers will be added. |
Technical |
APRN providers will be added. |
N/A |
APRN, physician, optometrist, FQHC, portable x-ray supplier, radiological lab, and physiological lab providers will be added; hospital providers will be removed. |
Intraoperative Neurophysiology Monitoring
Procedure codes 95940 and 95941 will be updated to add audiologist providers for services rendered in the inpatient and outpatient hospital settings.
Motion Analysis Studies
Procedure codes 96000, 96001, 96002, and 96003 will be updated to add APRN providers for services rendered in the office setting.
Other Procedure Code Updates
The professional component of electroencephalogram procedure code 95822 will be updated, and the total and technical components will become a benefit as follows:
Component |
Office Setting |
Inpatient Hospital Setting |
Outpatient Hospital Setting |
Total |
Physician, portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
N/A |
Hospital providers will be added. |
Professional |
APRN and physician providers will be added. |
APRN, certified nurse midwife, registered nurse, physician, portable x-ray supplier, radiological lab, and physiological lab providers will be removed. |
APRN, certified nurse midwife, registered nurse, physician, portable x-ray supplier, radiological lab, and physiological lab providers will be removed. |
Technical |
APRN, physician, radiation therapy center, portable x-ray supplier, radiological lab, and physiological lab providers will be added. |
N/A |
Radiation therapy center providers will be added. |
Payable Diagnosis Codes
EMG and NCS procedure codes will be a benefit for the following updated list of diagnosis codes:
Diagnosis Codes |
||||||
C701 |
C720 |
C721 |
D510 |
D511 |
D513 |
D518 |
D519 |
D538 |
E0842 |
E0942 |
E1041 |
E1042 |
E10610 |
E1141 |
E1142 |
E1144 |
E11610 |
E1342 |
E5111 |
E5112 |
E512 |
E518 |
E519 |
E52 |
E530 |
E531 |
E538 |
E550 |
E559 |
E560 |
E568 |
E610 |
E7281 |
E7289 |
E7841 |
E7849 |
E786 |
E851 |
E852 |
E853 |
E8581 |
E8582 |
E8589 |
E859 |
G120 |
G121 |
G1221 |
G1222 |
G1223 |
G1224 |
G1225 |
G1229 |
G128 |
G129 |
G130 |
G243 |
G2589 |
G260 |
G320 |
G360 |
G370 |
G375 |
G501 |
G510 |
G511 |
G512 |
G5131 |
G5132 |
G5133 |
G5139 |
G514 |
G518 |
G519 |
G522 |
G523 |
G527 |
G528 |
G540 |
G541 |
G542 |
G543 |
G544 |
G545 |
G548 |
G549 |
G5601 |
G5602 |
G5603 |
G5611 |
G5612 |
G5613 |
G5621 |
G5622 |
G5623 |
G5631 |
G5632 |
G5633 |
G5641 |
G5642 |
G5643 |
G5681 |
G5682 |
G5683 |
G5691 |
G5692 |
G5693 |
G5701 |
G5702 |
G5703 |
G5711 |
G5712 |
G5713 |
G5721 |
G5722 |
G5723 |
G5731 |
G5732 |
G5733 |
G5741 |
G5742 |
G5743 |
G5751 |
G5752 |
G5753 |
G5761 |
G5762 |
G5763 |
G5771 |
G5772 |
G5773 |
G5781 |
G5782 |
G5783 |
G5791 |
G5792 |
G5793 |
G587 |
G588 |
G589 |
G590 |
G600 |
G601 |
G602 |
G603 |
G608 |
G609 |
G610 |
G6181 |
G6182 |
G6189 |
G619 |
G620 |
G621 |
G622 |
G6281 |
G6282 |
G629 |
G630 |
G650 |
G651 |
G652 |
G7000 |
G7001 |
G701 |
G702 |
G7081 |
G7089 |
G709 |
G7100 |
G7101 |
G7102 |
G7109 |
G7111 |
G7112 |
G7113 |
G7114 |
G7119 |
G7120 |
G7121 |
G71220 |
G71228 |
G7129 |
G713 |
G718 |
G719 |
G721 |
G722 |
G723 |
G7241 |
G7249 |
G7281 |
G7289 |
G729 |
G731 |
G733 |
G737 |
G800 |
G801 |
G802 |
G803 |
G804 |
G808 |
G809 |
G8311 |
G8312 |
G8313 |
G8314 |
G8321 |
G8322 |
G8323 |
G8324 |
G834 |
G8381 |
G8382 |
G8383 |
G8384 |
G8389 |
G839 |
G9009 |
G902 |
G904 |
G9050 |
G90511 |
G90512 |
G90513 |
G90519 |
G90521 |
G90522 |
G90523 |
G90529 |
G9059 |
G909 |
G950 |
G9511 |
G9519 |
G9520 |
G9529 |
G9581 |
G9589 |
G959 |
G990 |
G992 |
I776 |
I951 |
J3800 |
J3801 |
J3802 |
K5902 |
K5903 |
K5904 |
K5909 |
K592 |
K594 |
K624 |
K6289 |
M05411 |
M05412 |
M05421 |
M05422 |
M05431 |
M05432 |
M05441 |
M05442 |
M05451 |
M05452 |
M05461 |
M05462 |
M05471 |
M05472 |
M0549 |
M05511 |
M05512 |
M05521 |
M05522 |
M05531 |
M05532 |
M05541 |
M05542 |
M05551 |
M05552 |
M05561 |
M05562 |
M05571 |
M05572 |
M0559 |
M05711 |
M05712 |
M05721 |
M05722 |
M05731 |
M05732 |
M05741 |
M05742 |
M05751 |
M05752 |
M05761 |
M05762 |
M05769 |
M05771 |
M05772 |
M05779 |
M0579 |
M057A |
M05811 |
M05812 |
M05821 |
M05822 |
M05831 |
M05832 |
M05841 |
M05842 |
M05851 |
M05852 |
M05861 |
M05862 |
M05871 |
M05872 |
M0589 |
M058A |
M06011 |
M06012 |
M06021 |
M06022 |
M06031 |
M06032 |
M06041 |
M06042 |
M06051 |
M06052 |
M06061 |
M06062 |
M06071 |
M06072 |
M0608 |
M0609 |
M060A |
M06811 |
M06812 |
M06821 |
M06822 |
M06831 |
M06832 |
M06841 |
M06842 |
M06852 |
M06861 |
M06862 |
M06871 |
M06872 |
M0688 |
M0689 |
M068A |
M069 |
M21271 |
M21272 |
M21331 |
M21332 |
M21511 |
M21512 |
M216X1 |
M216X2 |
M21831 |
M21832 |
M21931 |
M21932 |
M320 |
M3210 |
M3211 |
M3212 |
M3213 |
M3214 |
M3215 |
M3219 |
M328 |
M329 |
M3300 |
M3301 |
M3302 |
M3309 |
M3310 |
M3311 |
M3312 |
M3319 |
M3320 |
M3321 |
M3322 |
M3329 |
M3390 |
M3391 |
M3392 |
M3399 |
M340 |
M341 |
M342 |
M3481 |
M3482 |
M3483 |
M3489 |
M3500 |
M3501 |
M3502 |
M3503 |
M3504 |
M3505 |
M3506 |
M3507 |
M3508 |
M3509 |
M350A |
M350B |
M350C |
M3581 |
M3589 |
M360 |
M4321 |
M4322 |
M4323 |
M4324 |
M4325 |
M4326 |
M4327 |
M4328 |
M436 |
M438X9 |
M4644 |
M4645 |
M4646 |
M4647 |
M4711 |
M4712 |
M4713 |
M4714 |
M4715 |
M4716 |
M4721 |
M4722 |
M4723 |
M4724 |
M4725 |
M4726 |
M4727 |
M4728 |
M47811 |
M47812 |
M47813 |
M47814 |
M47815 |
M47816 |
M47817 |
M47818 |
M47891 |
M47892 |
M47893 |
M47894 |
M47895 |
M47896 |
M47897 |
M47898 |
M4801 |
M4802 |
M4803 |
M4804 |
M4805 |
M48062 |
M4807 |
M4808 |
M5000 |
M5001 |
M50020 |
M50021 |
M50022 |
M50023 |
M5003 |
M5011 |
M50120 |
M50121 |
M50122 |
M50123 |
M5013 |
M5020 |
M5021 |
M50220 |
M50221 |
M50222 |
M50223 |
M5023 |
M5030 |
M5031 |
M50320 |
M50321 |
M50322 |
M50323 |
M5033 |
M5080 |
M5081 |
M50820 |
M50821 |
M50822 |
M50823 |
M5083 |
M5091 |
M50920 |
M50921 |
M50922 |
M50923 |
M5093 |
M5104 |
M5105 |
M5106 |
M5124 |
M5125 |
M5126 |
M5127 |
M5134 |
M5135 |
M5136 |
M5137 |
M5184 |
M5185 |
M5186 |
M5187 |
M5410 |
M5411 |
M5412 |
M5413 |
M5414 |
M5415 |
M5416 |
M5417 |
M5431 |
M5432 |
M5451 |
M5459 |
M546 |
M5489 |
M5450 |
M5451 |
M5459 |
M60011 |
M60012 |
M60021 |
M60022 |
M60031 |
M60032 |
M60041 |
M60042 |
M60044 |
M60045 |
M60046 |
M60051 |
M60052 |
M60061 |
M60062 |
M60070 |
M60071 |
M60073 |
M60074 |
M60076 |
M60077 |
M6008 |
M6009 |
M60111 |
M60112 |
M60121 |
M60122 |
M60131 |
M60132 |
M60141 |
M60142 |
M60151 |
M60152 |
M60161 |
M60162 |
M60171 |
M60172 |
M6018 |
M6019 |
M6090 |
M6250 |
M62511 |
M62512 |
M62519 |
M62521 |
M62522 |
M62529 |
M62531 |
M62532 |
M62539 |
M62541 |
M62542 |
M62549 |
M62551 |
M62552 |
M62559 |
M62561 |
M62562 |
M62569 |
M62571 |
M62572 |
M62579 |
M6258 |
M6259 |
M6281 |
M6284 |
M629 |
M7910 |
M7911 |
M7912 |
M7918 |
M792 |
M79601 |
M79602 |
M79604 |
M79605 |
M79621 |
M79622 |
M79631 |
M79632 |
M79641 |
M79642 |
M79651 |
M79652 |
M79661 |
M79662 |
M79671 |
M79672 |
M797 |
M961 |
N393 |
N3941 |
N3942 |
N3943 |
N3944 |
N3945 |
N3946 |
N39490 |
N39491 |
N39492 |
N39498 |
N94819 |
R150 |
R151 |
R152 |
R159 |
R200 |
R201 |
R202 |
R203 |
R208 |
R209 |
R260 |
R261 |
R2681 |
R2689 |
R269 |
R290 |
R295 |
R29701 |
R29702 |
R29703 |
R29704 |
R29705 |
R29706 |
R29707 |
R29708 |
R29709 |
R29710 |
R29711 |
R29712 |
R29713 |
R29714 |
R29715 |
R29716 |
R29717 |
R29718 |
R29719 |
R29720 |
R29721 |
R29722 |
R29723 |
R29724 |
R29725 |
R29726 |
R29727 |
R29728 |
R29729 |
R29730 |
R29731 |
R29732 |
R29733 |
R29734 |
R29735 |
R29736 |
R29737 |
R29738 |
R29739 |
R29740 |
R29741 |
R29742 |
R320 |
R3914 |
R39191 |
R39192 |
R39198 |
R4702 |
R471 |
R4781 |
R4789 |
R498 |
R6884 |
S14101A |
S14101D |
S14101S |
S14102A |
S14102D |
S14102S |
S14103A |
S14103D |
S14103S |
S14104A |
S14104D |
S14104S |
S14105A |
S14105D |
S14105S |
S14106A |
S14106D |
S14106S |
S14107A |
S14107D |
S14107S |
S14108A |
S14108D |
S14108S |
S14109A |
S14109D |
S14109S |
S14111A |
S14111D |
S14111S |
S14112A |
S14112D |
S14112S |
S14113A |
S14113D |
S14113S |
S14114A |
S14114D |
S14114S |
S14115A |
S14115D |
S14115S |
S14116A |
S14116D |
S14116S |
S14117A |
S14117D |
S14117S |
S14118A |
S14118D |
S14118S |
S14121A |
S14121D |
S14121S |
S14122A |
S14122D |
S14122S |
S14123A |
S14123D |
S14123S |
S14124A |
S14124D |
S14124S |
S14125A |
S14125D |
S14125S |
S14126A |
S14126D |
S14126S |
S14127A |
S14127D |
S14127S |
S14128A |
S14128D |
S14128S |
S14131A |
S14131D |
S14131S |
S14132A |
S14132D |
S14132S |
S14133A |
S14133D |
S14133S |
S14134A |
S14134D |
S14134S |
S14135A |
S14135D |
S14135S |
S14136A |
S14136D |
S14136S |
S14137A |
S14137D |
S14137S |
S14138A |
S14138D |
S14138S |
S14141A |
S14141D |
S14141S |
S14142A |
S14142D |
S14142S |
S14143A |
S14143D |
S14143S |
S14144A |
S14144D |
S14144S |
S14145A |
S14145D |
S14145S |
S14146A |
S14146D |
S14146S |
S14147A |
S14147D |
S14147S |
S14148A |
S14148D |
S14148S |
S14151A |
S14151D |
S14151S |
S14152A |
S14152D |
S14152S |
S14153A |
S14153D |
S14153S |
S14154A |
S14154D |
S14154S |
S14155A |
S14155D |
S14155S |
S14156A |
S14156D |
S14156S |
S14157A |
S14157D |
S14157S |
S14158A |
S14158D |
S14158S |
S142XXA |
S142XXD |
S142XXS |
S143XXA |
S143XXD |
S143XXS |
S144XXA |
S144XXD |
S144XXS |
S145XXA |
S145XXD |
S145XXS |
S148XXA |
S148XXD |
S148XXS |
S149XXA |
S149XXD |
S149XXS |
S24101A |
S24101D |
S24101S |
S24102A |
S24102D |
S24102S |
S24103A |
S24103D |
S24103S |
S24104A |
S24104D |
S24104S |
S24109A |
S24109D |
S24109S |
S24111A |
S24111D |
S24111S |
S24112A |
S24112D |
S24112S |
S24113A |
S24113D |
S24113S |
S24114A |
S24114D |
S24114S |
S24131A |
S24131D |
S24131S |
S24132A |
S24132D |
S24132S |
S24133A |
S24133D |
S24133S |
S24134A |
S24134D |
S24134S |
S24141A |
S24141D |
S24141S |
S24142A |
S24142D |
S24142S |
S24143A |
S24143D |
S24143S |
S24144A |
S24144D |
S24144S |
S24151A |
S24151D |
S24151S |
S24152A |
S24152D |
S24152S |
S24153A |
S24153D |
S24153S |
S24154A |
S24154D |
S24154S |
S242XXA |
S242XXD |
S242XXS |
S243XXA |
S243XXD |
S243XXS |
S244XXA |
S244XXD |
S244XXS |
S248XXA |
S248XXD |
S248XXS |
S249XXA |
S249XXD |
S249XXS |
S34109A |
S34109D |
S34109S |
S34111A |
S34111D |
S34111S |
S34112A |
S34112D |
S34112S |
S34113A |
S34113D |
S34113S |
S34114A |
S34114D |
S34114S |
S34115A |
S34115D |
S34115S |
S34121A |
S34121D |
S34121S |
S34122A |
S34122D |
S34122S |
S34123A |
S34123D |
S34123S |
S34124A |
S34124D |
S34124S |
S34125A |
S34125D |
S34125S |
S34131A |
S34131D |
S34131S |
S34132A |
S34132D |
S34132S |
S34139A |
S34139D |
S34139S |
S3421XA |
S3421XD |
S3421XS |
S3422XA |
S3422XD |
S3422XS |
S343XXA |
S343XXD |
S343XXS |
S344XXA |
S344XXD |
S344XXS |
S345XXA |
S345XXD |
S345XXS |
S4400XA |
S4400XD |
S4400XS |
S4400XX |
S4401XA |
S4401XD |
S4401XS |
S4402XA |
S4402XD |
S4402XS |
S4410XA |
S4410XD |
S4410XS |
S4411XA |
S4411XD |
S4411XS |
S4412XA |
S4412XD |
S4412XS |
S4420XA |
S4420XD |
S4420XS |
S4421XA |
S4421XD |
S4421XS |
S4422XA |
S4422XD |
S4422XS |
S4430XA |
S4430XD |
S4430XS |
S4431XA |
S4431XD |
S4431XS |
S4432XA |
S4432XD |
S4432XS |
S4440XA |
S4440XD |
S4440XS |
S4441XA |
S4441XD |
S4441XS |
S4442XA |
S4442XD |
S4442XS |
S4450XA |
S4450XD |
S4450XS |
S4451XA |
S4451XD |
S4451XS |
S4452XA |
S4452XD |
S4452XS |
S448X1A |
S448X1D |
S448X1S |
S448X2A |
S448X2D |
S448X2S |
S448X9A |
S448X9D |
S448X9S |
S4490XA |
S4490XD |
S4490XS |
S4491XA |
S4491XD |
S4491XS |
S4492XA |
S4492XD |
S4492XS |
S5400XA |
S5400XD |
S5400XS |
S5401XA |
S5401XD |
S5401XS |
S5402XA |
S5402XD |
S5402XS |
S5410XA |
S5410XD |
S5410XS |
S5411XA |
S5411XD |
S5411XS |
S5412XA |
S5412XD |
S5412XS |
S5420XA |
S5420XD |
S5420XS |
S5421XA |
S5421XD |
S5421XS |
S5422XA |
S5422XD |
S5422XS |
S5430XA |
S5430XD |
S5430XS |
S5431XA |
S5431XD |
S5431XS |
S5432XA |
S5432XD |
S5432XS |
S5490XA |
S5490XD |
S5490XS |
S5491XA |
S5491XD |
S5491XS |
S5492XA |
S5492XD |
S5492XS |
S6400XA |
S6400XD |
S6400XS |
S6401XA |
S6401XD |
S6401XS |
S6402XA |
S6402XD |
S6402XS |
S6410XA |
S6410XD |
S6410XS |
S6411XA |
S6411XD |
S6411XS |
S6412XA |
S6412XD |
S6412XS |
S6420XA |
S6420XD |
S6420XS |
S6421XA |
S6421XD |
S6421XS |
S6422XA |
S6422XD |
S6422XS |
S6430XA |
S6430XD |
S6430XS |
S6431XA |
S6431XD |
S6431XS |
S6432XA |
S6432XD |
S6432XS |
S64490A |
S64490D |
S64490S |
S64491A |
S64491D |
S64491S |
S64492A |
S64492D |
S64492S |
S64493A |
S64493D |
S64493S |
S64494A |
S64494D |
S64494S |
S64495A |
S64495D |
S64495S |
S64496A |
S64496D |
S64496S |
S64497A |
S64497D |
S64497S |
S64498A |
S64498D |
S64498S |
S648X1A |
S648X1D |
S648X1S |
S648X2A |
S648X2D |
S648X2S |
S648X9A |
S648X9D |
S648X9S |
S6490XA |
S6490XD |
S6490XS |
S6491XA |
S6491XD |
S6491XS |
S6492XA |
S6492XD |
S6492XS |
S7401XA |
S7401XD |
S7401XS |
S7402XA |
S7402XD |
S7402XS |
S7411XA |
S7411XD |
S7411XS |
S7412XA |
S7412XD |
S7412XS |
S7421XA |
S7421XD |
S7421XS |
S7422XA |
S7422XD |
S7422XS |
S748X1A |
S748X1D |
S748X1S |
S748X2A |
S748X2D |
S748X2S |
S7491XA |
S7491XD |
S7491XS |
S7492XA |
S7492XD |
S7492XS |
S8401XA |
S8401XD |
S8401XS |
S8402XA |
S8402XD |
S8402XS |
S8410XS |
S8411XA |
S8411XD |
S8411XS |
S8412XA |
S8412XD |
S8412XS |
S8421XA |
S8421XD |
S8421XS |
S8422XA |
S8422XD |
S8422XS |
S84801A |
S84801D |
S84801S |
S84802A |
S84802D |
S84802S |
S8491XA |
S8491XD |
S8491XS |
S8492XA |
S8492XD |
S8492XS |
S9421XA |
S9421XD |
S9421XS |
S9422XA |
S9422XD |
S9422XS |
S9431XA |
S9431XD |
S9431XS |
S9432XA |
S9432XD |
S9432XS |
S948X1A |
S948X1D |
S948X1S |
S948X2A |
S948X2D |
S948X2S |
S948X9A |
S948X9D |
S948X9S |
S9490XA |
S9490XD |
S9490XS |
S9491XA |
S9491XD |
S9491XS |
S9492XA |
S9492XD |
S9492XS |
T85840A |
T85840D |
T85840S |
Diagnosis Codes Currently Covered
Vestibular evoked myogenic potentials procedure codes 92517, 92518, and 92519 may be reimbursed when submitted with diagnosis code R112.
Providers may refer to the current CSHCN Services Program Provider Manual, Chapter 31: Physician, subsection 31.2.19.3.1 “Vestibular Evoked Myogenic Potentials (VEMP),” for additional currently payable diagnosis codes.
For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.