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Trailblazer Clarification on Updated Policy for EDX Services

Effective May 1, Trailblazer, the Medicare Administrative Contractor (MAC) for Texas, Colorado, New Mexico, and Oklahoma, began requiring additional information before any claims with NCS codes 95900-95904 are paid.  Due to multiple questions, they have provided the following clarifications to their policy for EDX services:

1. The performing/supervising physician must indicate board certification status (e.g., active, inactive) and the name of the certifying board when submitting claims. For Medicare payment purposes, certifying boards are:  
  • American Board of Psychiatry and Neurology
  • American Board of Osteopathic Neurology and Psychiatry
  • American Board of Physical Medicine and Rehabilitation
  • American Board of Electrodiagnostic Medicine
  • American Board of Psychiatry and Neurology subspecialty certification in Clinical Neurophysiology
  • Osteopathic Board of Physical Medicine and Rehabilitation
2. The claim must also indicate the manufacturer and model name/number of testing equipment.

3. If submitting bills electronically, this information may be added to Loop 2300, NTE segment (i.e., the comment field). If billing a paper claim, an attachment that includes the necessary information will be accepted.

4. MOST IMPORTANTLY: The modifier KX (specified required documentation is on file in our office) must be appended to the CPT codes for EMG and NCS services to certify that all services were performed according to the provisions of the policy for reimbursement of EDX services. Failure to provide this modifier will result in the claim being denied as not reasonable and necessary.

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