Payer Resources

Clarifies what constitutes an acceptable NCS waveform, including proper techniques and necessary qualifications

Identifies characteristics of mobile diagnostic testing companies that may be offering substandard electrodiagnostic (EDX) services. Because substandard and inaccurate diagnoses delay appropriate care, these types of services are negatively impacting the quality of EDX examinations delivered to patients across the United States.

Defines the terms “on site” and “real time” as used in the AMA’s CPT codebook for nerve conduction studies. Can be utilized to combat fraud and abuse by providers that are not providing the quality of care required to bill the codes.

Explains that a properly trained physician should perform (or, in the case of NCS, at least supervise) and interpret nerve conduction study (NCS) and needle EMG data on site and in real time. Additionally, in the majority of situations, both a needle EMG and NCS should be performed together.

Helps identify overutilization by providing detailed information on appropriate coding and billing. This document is frequently used by insurance companies when developing policies. Share with your insurance company.

Provides insurance companies with language they can easily adapt to their policies outlining AANEM’s key positions. Describes a typical EDX examination, when EDX testing is indicated, explains the performance of the tests with reference to the CPT codes, the limitations of the studies, the maximum number of tests needed in 90% of cases, timing of testing after an injury, and frequency of testing.

Provides insurance companies with language they can easily adapt to their policies outlining AANEM’s key positions. Describes qualifications of EDX providers – for both needle EMGs and nerve conduction studies (NCS). Share with your insurance providers!

Demonstrates that value based (VB) payment models for electrodiagnostic (EDX) services provide quality patient care, ensure timely treatment, and reduce health care costs. Explains how a value-based reimbursement system for properly-performed EDX testing and assessment of a patient will increase the value of each healthcare dollar spent. A sample payment method is included.