Blue Cross Blue Shield - MA EMG/NCS Coverage

Coverage Criteria

inv-01: Initial electrodiagnostic assessment — medical necessity

Covered when ALL of the following are met

Primary criteria: Signs and symptoms of peripheral neuropathy and/or myopathy are present; AND definitive diagnosis cannot be made by physical examination and imaging studies alone; AND work-up for one or more of the listed categories of disease is indicated (eg, compressive neuropathies, nerve root compression, traumatic nerve injuries, generalized and focal neuropathies/myopathies, plexopathies, motor neuron diseases, neuromuscular junction disorders).

Categories and example diagnoses are enumerated in policy.

inv-02: Repeat electrodiagnostic assessment

Repeat testing considered medically necessary when ANY of the following are met

Repeat testing criteria: Development of new symptoms or signs suggesting a second diagnosis in an individual who has received an initial diagnosis; OR interim progression of disease after an initial inconclusive test such that repeat testing is likely to elicit additional findings; OR unexpected change(s) in disease course or response to treatment suggesting initial diagnosis may be incorrect and reexamination is indicated.

inv-03: Coverage conditioned on medical necessity criteria (Section A)

Covered when ALL of the following are met:

Section A requirement: The medical necessity criteria in Section A must be met for the listed CPT codes to be covered for Commercial Members (Managed Care, PPO, Indemnity).

Providers must use current coding and meet documentation standards; intraoperative EMG requires concurrent intraoperative monitoring CPT code as per policy #211.

The policy excludes use of electrodiagnostic assessment for certain applications where clinical benefit has not been established. Specifically, EMG/NCS are considered investigational and therefore not covered when performed for screening of asymptomatic individuals, for serial assessments to evaluate progression in a person with an established neuropathy or myopathy, for evaluation of treatment response in a previously diagnosed condition, or for assessment of disease severity in someone with a known neuropathy or myopathy. These exclusions do not apply when testing is being performed intraoperatively under policy #211 and the intraoperative criteria are met.

Inclusion or exclusion of a CPT or ICD-10 code in this policy is informational only and does not by itself guarantee member coverage or provider reimbursement. Actual coverage depends on the member’s contract benefits in effect at the time of service and whether the service meets the medical necessity criteria specified in Section A. Providers must report services using current, industry-standard procedure and diagnosis codes and meet the documentation and medical necessity requirements for Commercial Members for the CPT codes listed in Section A to be covered.

When electrodiagnostic assessment is used solely for screening asymptomatic individuals or for serial assessments to monitor progression of a previously diagnosed neuropathy or myopathy (including evaluating response to treatment or determining severity), the policy deems these uses investigational and not medically necessary; such claims would be subject to denial under the investigational/not medically necessary provisions of the policy.

The evidence base for electrodiagnostic assessment (EMG/NCS) consists mainly of small observational studies for selected diagnoses (for example, carpal tunnel syndrome, radiculopathy, and myopathy). Although EMG/NCS are considered the criterion standard for assessing peripheral nerve and muscle electrical function, available studies show variable and often low sensitivity (frequently <50%) while specificity is generally higher but imprecisely estimated. Overall, the evidence is insufficient to demonstrate that electrodiagnostic assessment leads to improved health net outcomes for some indications.

Coding

Covered CPT Codes (Section A — requires medical necessity criteria)CPTCovered

95940	Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure).
95941	Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure).
95860	Needle electromyography; 1 extremity with or without related paraspinal areas.
95861	Needle electromyography; 2 extremities with or without related paraspinal areas.
95863	Needle electromyography; 3 extremities with or without related paraspinal areas.
95864	Needle electromyography; 4 extremities with or without related paraspinal areas.
95865	Needle electromyography; larynx.
95866	Needle electromyography; hemidiaphragm.
95867	Needle electromyography; cranial nerve supplied muscle(s), unilateral.
95868	Needle electromyography; cranial nerve supplied muscles, bilateral.

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ICD-10 Diagnosis Codes considered medically necessary when submitted with the CPT codes aboveICD-10

A52.15	Late Syphilitic Neuropathy.
C41.2	Malignant neoplasm of vertebral column.
C70.0	Malignant neoplasm of cerebral meninges.
C70.1	Malignant neoplasm of spinal meninges.
C71.0	Malignant neoplasm of cerebrum, except lobes and ventricles.
C71.1	Malignant neoplasm of frontal lobe.
C71.2	Malignant neoplasm of temporal lobe.
C71.3	Malignant neoplasm of parietal lobe.
C71.4	Malignant neoplasm of occipital lobe.
C71.5	Malignant neoplasm of cerebral ventricle.

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Neuromuscular and polyneuropathy ICD-10 CodesICD-10

G61.89	Other Inflammatory Polyneuropathies / Multifocal motor neuropathy.
G61.9	Inflammatory Polyneuropathy, Unspecified.
G62.0	Drug-Induced Polyneuropathy.
G62.2	Polyneuropathy Due To Other Toxic Agents.
G62.81	Critical Illness Polyneuropathy.
G62.82	Radiation-Induced Polyneuropathy.
G62.89	Other Specified Polyneuropathies.
G62.9	Polyneuropathy, Unspecified.
G63	Polyneuropathy In Diseases Classified Elsewhere.
G64	Other Disorders Of Peripheral Nervous System.

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Muscular dystrophy and myopathy ICD-10 CodesICD-10

G71.02	Facioscapulohumeral muscular dystrophy.
G71.031	Autosomal dominant limb girdle muscular dystrophy.
G71.032	Autosomal recessive limb girdle muscular dystrophy due to calpain-3 dysfunction.
G71.033	Limb girdle muscular dystrophy due to dysferlin dysfunction.
G71.0340	Limb girdle muscular dystrophy due to sarcoglycan dysfunction, unspecified.
G71.0341	Limb girdle muscular dystrophy due to alpha sarcoglycan dysfunction.
G71.0342	Limb girdle muscular dystrophy due to beta sarcoglycan dysfunction.
G71.0349	Limb girdle muscular dystrophy due to other sarcoglycan dysfunction.
G71.035	Limb girdle muscular dystrophy due to anoctamin-5 dysfunction.
G71.036	Limb girdle muscular dystrophy due to fukutin related protein dysfunction.

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Autonomic, pain, and sensory disturbance ICD-10 CodesICD-10

G90.09	Other Idiopathic Peripheral Autonomic Neuropathy.
G90.4	Autonomic Dysreflexia.
G90.50	Complex Regional Pain Syndrome I, Unspecified.
G90.511	Complex Regional Pain Syndrome I Of Right Upper Limb.
G90.512	Complex Regional Pain Syndrome I Of Left Upper Limb.
G90.513	Complex Regional Pain Syndrome I Of Upper Limb, Bilateral.
G90.519	Complex Regional Pain Syndrome I Of Unspecified Upper Limb.
M62.81	Muscle weakness (generalized).
M79.601	Pain in right arm.
R20.0	Anesthesia of skin.

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Cranial nerve injury and cervical spinal cord injury ICD-10 CodesICD-10

S04.20XA	Injury Of Trochlear Nerve, Unspecified Side, Initial Encounter.
S04.21XA	Injury Of Trochlear Nerve, Right Side, Initial Encounter.
S04.22XA	Injury Of Trigeminal Nerve, Left Side, Subsequent Encounter (fragmented listing).
S04.30XA	Injury Of Trigeminal Nerve, Unspecified Side, Initial Encounter.
S04.40XA	Injury Of Abducent Nerve, Unspecified Side, Initial Encounter.
S04.50XA	Injury Of Facial Nerve, Unspecified Side, Initial Encounter.
S04.60XA	Injury Of Acoustic Nerve, Unspecified Side, Initial Encounter.
S04.70XA	Injury Of Accessory Nerve, Unspecified Side, Initial Encounter.
S04.811A	Injury Of Olfactory Nerve, Right Side, Initial Encounter.
S04.819A	Injury Of Olfactory Nerve, Unspecified Side, Initial Encounter.

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Cervical spinal cord syndromes and encounter codesICD-10

S14.129A	Central Cord Syndrome At Unspecified Level Of Cervical Spinal Cord, Initial Encounter.
S14.129D	Central Cord Syndrome At Unspecified Level Of Cervical Spinal Cord, Subsequent Encounter.
S14.129S	Central Cord Syndrome At Unspecified Level Of Cervical Spinal Cord, Sequela.
S14.131A	Anterior Cord Syndrome At C1 Level Of Cervical Spinal Cord, Initial Encounter.
S14.131D	Anterior Cord Syndrome At C1 Level Of Cervical Spinal Cord, Subsequent Encounter.
S14.131S	Anterior Cord Syndrome At C1 Level Of Cervical Spinal Cord, Sequela.
S14.132A	Anterior Cord Syndrome At C2 Level Of Cervical Spinal Cord, Initial Encounter.
S14.132D	Anterior Cord Syndrome At C2 Level Of Cervical Spinal Cord, Subsequent Encounter.
S14.132S	Anterior Cord Syndrome At C2 Level Of Cervical Spinal Cord, Sequela.

Additional cervical cord syndromes and incomplete lesionsICD-10

S14.141A	Brown-Sequard Syndrome At C1 Level Of Cervical Spinal Cord, Initial Encounter.
S14.141D	Brown-Sequard Syndrome At C1 Level Of Cervical Spinal Cord, Subsequent Encounter.
S14.141S	Brown-Sequard Syndrome At C1 Level Of Cervical Spinal Cord, Sequela.
S14.142A	Brown-Sequard Syndrome At C2 Level Of Cervical Spinal Cord, Initial Encounter.
S14.142D	Brown-Sequard Syndrome At C2 Level Of Cervical Spinal Cord, Subsequent Encounter.
S14.142S	Brown-Sequard Syndrome At C2 Level Of Cervical Spinal Cord, Sequela.
S14.151A	Other Incomplete Lesion At C1 Level Of Cervical Spinal Cord, Initial Encounter.
S14.151D	Other Incomplete Lesion At C1 Level Of Cervical Spinal Cord, Subsequent Encounter.
S14.151S	Other Incomplete Lesion At C1 Level Of Cervical Spinal Cord, Sequela.

Thoracic spinal cord injuriesICD-10

S24.0XXA	Concussion And Edema Of Thoracic Spinal Cord, Initial Encounter.
S24.0XXD	Concussion And Edema Of Thoracic Spinal Cord, Subsequent Encounter.
S24.0XXS	Concussion And Edema Of Thoracic Spinal Cord, Sequela.
S24.101A	Unspecified Injury At T1 Level Of Thoracic Spinal Cord, Initial Encounter.
S24.101D	Unspecified Injury At T1 Level Of Thoracic Spinal Cord, Subsequent Encounter.
S24.101S	Unspecified Injury At T1 Level Of Thoracic Spinal Cord, Sequela.
S24.112A	Complete Lesion At T2-T6 Level Of Thoracic Spinal Cord, Initial Encounter.
S24.112D	Complete Lesion At T2-T6 Level Of Thoracic Spinal Cord, Subsequent Encounter.
S24.112S	Complete Lesion At T2-T6 Level Of Thoracic Spinal Cord, Sequela.

Thoracic cord syndromes (continued)ICD-10

S24.133A	Anterior Cord Syndrome At T7-T10 Level Of Thoracic Spinal Cord, Initial Encounter.
S24.133D	Anterior Cord Syndrome At T7-T10 Level Of Thoracic Spinal Cord, Subsequent Encounter.
S24.133S	Anterior Cord Syndrome At T7-T10 Level Of Thoracic Spinal Cord, Sequela.
S24.141A	Brown-Sequard Syndrome At T1 Level Of Thoracic Spinal Cord, Initial Encounter.
S24.141D	Brown-Sequard Syndrome At T1 Level Of Thoracic Spinal Cord, Subsequent Encounter.
S24.141S	Brown-Sequard Syndrome At T1 Level Of Thoracic Spinal Cord, Sequela.
S24.149A	Brown-Sequard Syndrome At Unspecified Level Of Thoracic Spinal Cord, Initial Encounter.

Lumbar and sacral spinal cord injury codesICD-10

S34.01XA	Concussion And Edema Of Lumbar Spinal Cord, Subsequent Encounter.
S34.01XD	Concussion And Edema Of Lumbar Spinal Cord, Subsequent Encounter.
S34.01XS	Concussion And Edema Of Lumbar Spinal Cord, Sequela.
S34.102A	Unspecified Injury To L2 Level Of Lumbar Spinal Cord, Initial Encounter.
S34.102S	Unspecified Injury To L2 Level Of Lumbar Spinal Cord, Sequela.
S34.111A	Complete Lesion Of L1 Level Of Lumbar Spinal Cord, Initial Encounter.
S34.111D	Complete Lesion Of L1 Level Of Lumbar Spinal Cord, Subsequent Encounter.
S34.111S	Complete Lesion Of L1 Level Of Lumbar Spinal Cord, Sequela.

Nerve root, plexus, cauda equina, peripheral nerve injury codesICD-10

S34.121A	Incomplete Lesion Of L1 Level Of Lumbar Spinal Cord, Initial Encounter.
S34.121D	Incomplete Lesion Of L1 Level Of Lumbar Spinal Cord, Subsequent Encounter.
S34.121S	Incomplete Lesion Of L1 Level Of Lumbar Spinal Cord, Sequela.
S34.21XA	Injury Of Nerve Root Of Lumbar Spine, Initial Encounter.
S34.22XA	Injury Of Nerve Root Of Sacral Spine, Initial Encounter.
S34.3XXA	Injury Of Cauda Equina, Initial Encounter.
S34.4XXA	Injury Of Lumbosacral Plexus, Initial Encounter.
S34.5XXA	Injury Of Lumbar, Sacral And Pelvic Sympathetic Nerves, Initial Encounter.
S44.00XA	Injury Of Ulnar Nerve At Upper Arm Level, Unspecified Arm, Initial Encounter.

ICD-10 Diagnosis Codes for nerve and spinal cord injuriesICD-10

S34.139D	Unspecified Injury To Sacral Spinal Cord, Subsequent Encounter.
S34.21XA	Injury Of Nerve Root Of Lumbar Spine, Initial Encounter.
S34.21XS	Injury Of Nerve Root Of Lumbar Spine, Sequela.
S34.22XA	Injury Of Nerve Root Of Sacral Spine, Initial Encounter.
S34.22XD	Injury Of Nerve Root Of Sacral Spine, Subsequent Encounter.
S34.3XXA	Injury Of Cauda Equina, Initial Encounter.
S34.4XXA	Injury Of Lumbosacral Plexus, Initial Encounter.
S34.4XXD	Injury Of Lumbosacral Plexus, Subsequent Encounter.
S34.5XXA	Injury Of Lumbar, Sacral And Pelvic Sympathetic Nerves, Initial Encounter.
S34.5XXD	Injury Of Lumbar, Sacral And Pelvic Sympathetic Nerves, Subsequent Encounter.

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ICD-10 codes: Hip and thigh nerve injuriesICD-10

S74.10XD	Injury Of Femoral Nerve At Hip And Thigh Level, Unspecified Leg, Subsequent Encounter.
S74.10XS	Injury Of Femoral Nerve At Hip And Thigh Level, Unspecified Leg, Sequela.
S74.11XA	Injury Of Femoral Nerve At Hip And Thigh Level, Right Leg, Initial Encounter.
S74.11XD	Injury Of Femoral Nerve At Hip And Thigh Level, Right Leg, Subsequent Encounter.
S74.11XS	Injury Of Femoral Nerve At Hip And Thigh Level, Right Leg, Sequela.
S74.12XA	Injury Of Femoral Nerve At Hip And Thigh Level, Left Leg, Initial Encounter.
S74.12XD	Injury Of Femoral Nerve At Hip And Thigh Level, Left Leg, Subsequent Encounter.
S74.20XA	Injury Of Cutaneous Sensory Nerve At Hip And Thigh Level, Unspecified Leg, Initial Encounter.
S74.20XD	Injury Of Cutaneous Sensory Nerve At Hip And Thigh Level, Unspecified Leg, Subsequent Encounter.
S74.20XS	Injury Of Cutaneous Sensory Nerve At Hip And Thigh Level, Unspecified Leg, Sequela.

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ICD-10 codes: continued hip and thigh nerve injuries / unspecified nerve injuriesICD-10

S74.22XD	Injury Of Cutaneous Sensory Nerve At Hip And Thigh Level, Left Leg, Subsequent Encounter.
S74.22XS	Injury Of Cutaneous Sensory Nerve At Hip And Thigh Level, Left Leg, Sequela.
S74.8X1A	Injury Of Other Nerves At Hip And Thigh Level, Right Leg, Initial Encounter.
S74.8X1D	Injury Of Other Nerves At Hip And Thigh Level, Right Leg, Subsequent Encounter.
S74.8X1S	Injury Of Other Nerves At Hip And Thigh Level, Right Leg, Sequela.
S74.8X2A	Injury Of Other Nerves At Hip And Thigh Level, Left Leg, Initial Encounter.
S74.8X2D	Injury Of Other Nerves At Hip And Thigh Level, Left Leg, Subsequent Encounter.
S74.8X2S	Injury Of Other Nerves At Hip And Thigh Level, Left Leg, Sequela.
S74.8X9A	Injury Of Other Nerves At Hip And Thigh Level, Unspecified Leg, Initial Encounter.
S74.8X9D	Injury Of Other Nerves At Hip And Thigh Level, Unspecified Leg, Subsequent Encounter.

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ICD-10 codes: lower leg nerve injuries (tibial, peroneal)ICD-10

S74.91XA	Injury Of Unspecified Nerve At Hip And Thigh Level, Right Leg, Initial Encounter.
S74.91XD	Injury Of Unspecified Nerve At Hip And Thigh Level, Right Leg, Subsequent Encounter.
S74.91XS	Injury Of Unspecified Nerve At Hip And Thigh Level, Right Leg, Sequela.
S74.92XA	Injury Of Unspecified Nerve At Hip And Thigh Level, Left Leg, Initial Encounter.
S74.92XD	Injury Of Unspecified Nerve At Hip And Thigh Level, Left Leg, Subsequent Encounter.
S84.00XA	Injury Of Tibial Nerve At Lower Leg Level, Unspecified Leg, Initial Encounter.
S84.00XS	Injury Of Tibial Nerve At Lower Leg Level, Unspecified Leg, Sequela.
S84.01XA	Injury Of Tibial Nerve At Lower Leg Level, Right Leg, Initial Encounter.
S84.01XD	Injury Of Tibial Nerve At Lower Leg Level, Right Leg, Subsequent Encounter.
S84.01XS	Injury Of Tibial Nerve At Lower Leg Level, Right Leg, Sequela.

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ICD-10 codes: cutaneous sensory and other lower leg nerve injuriesICD-10

S84.11XS	Injury Of Peroneal Nerve At Lower Leg Level, Right Leg, Sequela.
S84.12XA	Injury Of Peroneal Nerve At Lower Leg Level, Left Leg, Initial Encounter.
S84.12XD	Injury Of Peroneal Nerve At Lower Leg Level, Left Leg, Subsequent Encounter.
S84.12XS	Injury Of Peroneal Nerve At Lower Leg Level, Left Leg, Sequela.
S84.20XA	Injury Of Cutaneous Sensory Nerve At Lower Leg Level, Unspecified Leg, Initial Encounter.
S84.20XD	Injury Of Cutaneous Sensory Nerve At Lower Leg Level, Unspecified Leg, Subsequent Encounter.
S84.20XS	Injury Of Cutaneous Sensory Nerve At Lower Leg Level, Unspecified Leg, Sequela.
S84.21XA	Injury Of Cutaneous Sensory Nerve At Lower Leg Level, Right Leg, Initial Encounter.
S84.21XD	Injury Of Cutaneous Sensory Nerve At Lower Leg Level, Right Leg, Subsequent Encounter.
S84.21XS	Injury Of Cutaneous Sensory Nerve At Lower Leg Level, Right Leg, Sequela.

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ICD-10 codes: other and unspecified lower leg nerve injuriesICD-10

S84.22XS	Injury Of Cutaneous Sensory Nerve At Lower Leg Level, Left Leg, Sequela.
S84.801A	Injury Of Other Nerves At Lower Leg Level, Right Leg, Initial Encounter.
S84.801D	Injury Of Other Nerves At Lower Leg Level, Right Leg, Subsequent Encounter.
S84.801S	Injury Of Other Nerves At Lower Leg Level, Right Leg, Sequela.
S84.802A	Injury Of Other Nerves At Lower Leg Level, Left Leg, Initial Encounter.
S84.802D	Injury Of Other Nerves At Lower Leg Level, Left Leg, Subsequent Encounter.
S84.802S	Injury Of Other Nerves At Lower Leg Level, Left Leg, Sequela.
S84.809A	Injury Of Other Nerves At Lower Leg Level, Unspecified Leg, Initial Encounter.
S84.809D	Injury Of Other Nerves At Lower Leg Level, Unspecified Leg, Subsequent Encounter.
S84.809S	Injury Of Other Nerves At Lower Leg Level, Unspecified Leg, Sequela.

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ICD-10 codes: unspecified lower leg nerve injuries and plantar nerve injuriesICD-10

S84.90XD	Injury Of Unspecified Nerve At Lower Leg Level, Unspecified Leg, Subsequent Encounter.
S84.90XS	Injury Of Unspecified Nerve At Lower Leg Level, Unspecified Leg, Sequela.
S84.91XA	Injury Of Unspecified Nerve At Lower Leg Level, Right Leg, Initial Encounter.
S84.91XD	Injury Of Unspecified Nerve At Lower Leg Level, Right Leg, Subsequent Encounter.
S84.91XS	Injury Of Unspecified Nerve At Lower Leg Level, Right Leg, Sequela.
S84.92XA	Injury Of Unspecified Nerve At Lower Leg Level, Left Leg, Initial Encounter.
S84.92XD	Injury Of Unspecified Nerve At Lower Leg Level, Left Leg, Subsequent Encounter.
S94.00XA	Injury Of Lateral Plantar Nerve, Unspecified Leg, Initial Encounter.
S94.00XS	Injury Of Lateral Plantar Nerve, Unspecified Leg, Sequela.

ICD-10 codes: medial/lateral plantar nerve injuriesICD-10

S94.01XD	Injury Of Lateral Plantar Nerve, Right Leg, Subsequent Encounter.
S94.01XS	Injury Of Lateral Plantar Nerve, Right Leg, Sequela.
S94.02XA	Injury Of Lateral Plantar Nerve, Left Leg, Initial Encounter.
S94.02XD	Injury Of Lateral Plantar Nerve, Left Leg, Subsequent Encounter.
S94.02XS	Injury Of Lateral Plantar Nerve, Left Leg, Sequela.
S94.10XA	Injury Of Medial Plantar Nerve, Unspecified Leg, Initial Encounter.
S94.10XD	Injury Of Medial Plantar Nerve, Unspecified Leg, Subsequent Encounter.
S94.10XS	Injury Of Medial Plantar Nerve, Unspecified Leg, Sequela.
S94.11XA	Injury Of Medial Plantar Nerve, Right Leg, Initial Encounter.
S94.11XD	Injury Of Medial Plantar Nerve, Right Leg, Subsequent Encounter.

ICD-10 codes: deep peroneal nerve and ankle/foot-level injuriesICD-10

S94.11XS	Injury Of Medial Plantar Nerve, Right Leg, Sequela.
S94.12XA	Injury Of Medial Plantar Nerve, Left Leg, Initial Encounter.
S94.12XS	Injury Of Medial Plantar Nerve, Left Leg, Sequela.
S94.20XA	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Unspecified Leg, Initial Encounter.
S94.20XD	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Unspecified Leg, Subsequent Encounter.
S94.20XS	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Unspecified Leg, Sequela.
S94.21XA	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Right Leg, Initial Encounter.
S94.21XD	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Right Leg, Subsequent Encounter.
S94.21XS	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Right Leg, Sequela.
S94.22XA	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Left Leg, Initial Encounter.

ICD-10 codes: ankle and foot nerve injuries (continued)ICD-10

S94.22XD	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Left Leg, Subsequent Encounter.
S94.22XS	Injury Of Deep Peroneal Nerve At Ankle And Foot Level, Left Leg, Sequela.
S94.30XA	Injury Of Cutaneous Sensory Nerve At Ankle And Foot Level, Unspecified Leg, Initial Encounter.
S94.30XD	Injury Of Cutaneous Sensory Nerve At Ankle And Foot Level, Unspecified Leg, Subsequent Encounter.
S94.30XS	Injury Of Cutaneous Sensory Nerve At Ankle And Foot Level, Unspecified Leg, Sequela.
S94.31XA	Injury Of Cutaneous Sensory Nerve At Ankle And Foot Level, Right Leg, Initial Encounter.
S94.31XD	Injury Of Cutaneous Sensory Nerve At Ankle And Foot Level, Right Leg, Subsequent Encounter.
S94.31XS	Injury Of Cutaneous Sensory Nerve At Ankle And Foot Level, Right Leg, Sequela.
S94.32XA	Injury Of Cutaneous Sensory Nerve At Ankle And Foot Level, Left Leg, Initial Encounter.
S94.32XD	Injury Of Cutaneous Sensory Nerve At Ankle And Foot Level, Left Leg, Subsequent Encounter.

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ICD-10 codes: unspecified and other ankle/foot nerve injuries (final)ICD-10

S94.8X2D	Injury Of Other Nerves At Ankle And Foot Level, Left Leg, Subsequent Encounter.
S94.8X2S	Injury Of Other Nerves At Ankle And Foot Level, Left Leg, Sequela.
S94.8X9A	Injury Of Other Nerves At Ankle And Foot Level, Unspecified Leg, Initial Encounter.
S94.8X9D	Injury Of Other Nerves At Ankle And Foot Level, Unspecified Leg, Subsequent Encounter.
S94.8X9S	Injury Of Other Nerves At Ankle And Foot Level, Unspecified Leg, Sequela.
S94.90XA	Injury Of Unspecified Nerve At Ankle And Foot Level, Unspecified Leg, Initial Encounter.
S94.90XD	Injury Of Unspecified Nerve At Ankle And Foot Level, Unspecified Leg, Subsequent Encounter.
S94.90XS	Injury Of Unspecified Nerve At Ankle And Foot Level, Unspecified Leg, Sequela.
S94.91XA	Injury Of Unspecified Nerve At Ankle And Foot Level, Right Leg, Initial Encounter.
S94.91XD	Injury Of Unspecified Nerve At Ankle And Foot Level, Right Leg, Subsequent Encounter.

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Sensitivity of EMG/NCS

Reported sensitivityOften less than 50% across studies

SpecificityGenerally higher than sensitivity but imprecise in available data

Implication for practice

Provider Actions & Requirements

Documentation Required

Coding and documentation guidance

When submitting claims or prior authorization requests, include appropriate ICD-10 diagnosis codes from the lists in this policy to support medical necessity. Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.

Use listed ICD-10 diagnosis codes from the policy when submitting claims/authorization requests.
Report services with current procedure, revenue, and diagnosis codes and applicable modifiers.

Billing Rule

Intraoperative EMG coding requirement

Coverage of intraoperative electromyography monitoring (e.g., CPT 95940, 95941) requires that the medical necessity criteria in Section A are met and that intraoperative use follows the intent/requirements described (these codes must be used in conjunction with the intraoperative monitoring CPT codes per policy #211). See Section A (CPT Codes) and policy #211 for full intraoperative EMG coding and coverage rules.

Background

Electromyography (EMG) and nerve conduction studies (NCS) evaluate the electrical function of muscles and peripheral nerves and are used as adjuncts to clinical examination and imaging when a definitive diagnosis cannot be established by history, physical exam, and imaging alone. These studies help localize and characterize neuromuscular disorders and can assess severity and timing; modalities include needle EMG, repetitive nerve stimulation, somatosensory evoked potentials, and blink reflex testing.

Definitions

Needle Electromyography (EMG)

DefinitionNeedle EMG involves inserting a needle electrode into selected muscles to record muscle responses and evaluate resting activity and motor unit potentials.

Components evaluatedObservation at rest; action potential with minimal voluntary contraction; action potential with maximum contraction

Muscle selectionMuscles chosen by the examining physician based on the differential diagnosis and exam findings

Single‑fiber Electromyography

DefinitionSingle-fiber EMG records the response of a single muscle fiber to evaluate jitter and fiber density.

JitterVariability in the time between nerve activation and muscle action potential

OpenPayer

Electrodiagnostic assessment (EMG/NCS) — medical necessity and coverage criteria

Coverage Criteria

Coding

Provider Actions & Requirements

Background

Definitions