AANEM has been notified that the Center for Medicare and Medicaid Services (CMS) recently contracted with Safeguard Services to conduct a Comparative Billing study on EDX testing. The study’s results are scheduled for release December 6, 2011. The AANEM supports these CMS efforts to ensure that EDX testing is performed and billed correctly.
CMS indicated they conducted the study because EDX testing has been identified as an area of vulnerability in the Medicare program. CMS considers comparative billing reports a useful tool in verifying billing practices and as a first step in preventing improper or excessive billing.
The study analyzed nerve conduction studies (CPT Code 95900, 95903, 95904, 95905) and needle electromyography codes (95860, 95861, 95862, 95863, 95864) billed to CMS in 2010 for Medicare beneficiaries. It then compared the number of claims for each code with the state and national averages for similar providers.
It is important to note that the study did not include neurologists or physiatrists and was, instead, focused on other physician and non-physician providers. Therefore, it is highly unlikely that AANEM members will receive these reports.
Anyone receiving a report will be able to compare, per code, the number of claims filed per patient under their Provider ID number against the numbers of claims filed by other providers in the same state and nationwide. If you, or a colleague, have any questions about comparative billing reports, please contact the AANEM Policy Department at
policy@aanem.org.