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Evoked Response Test and Neuromuscular Procedure Benefits to Change for the CSHCN Services Program January 1, 2023

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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

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S5431XA

S5431XD

S5431XS

S5432XA

S5432XD

S5432XS

S5490XA

S5490XD

S5490XS

S5491XA

S5491XD

S5491XS

S5492XA

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S6400XA

S6400XD

S6400XS

S6401XA

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S6401XS

S6402XA

S6402XD

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S6410XA

S6410XD

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S6411XA

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S6412XA

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S6420XA

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S6421XA

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S6422XA

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S6430XA

S6430XD

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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.