Neurophysiological Studies - CPT 92585, 92586 - 95930


Neurophysiological studies for purpose of this LCD include: Somatosensory Evoked Potentials/Responses (SEPs/SERs), Brainstem Auditory Evoked Potentials/Responses (BAEPs/BAERs) and Visual Evoked Potentials/Responses (VERs/VEPs).

Evoked potential studies
are recorded electrical responses to stimulation of a sensory system. When a sensory impulse reaches the brain, a specific Electroencephalographic (EEG) response is produced (evoked) in the cortical area appropriate to the modality and site of the stimulus. By computer averaging techniques, the evoked responses of repetitive stimuli can be separated from the spontaneous EEG activity. Evoked potentials are clinically useful in evaluating the functional integrity of the somatosensory or special sensory pathways. Different latencies and wave patterns help to localize lesions ranging from the end organ through the nervous system to the cerebral cortex. Often defects in these pathways are not otherwise evident. Evoked potentials are also used to monitor neural pathways when patients are anesthetized during surgery and to document brain death. The following are tests that evaluate potentials evoked by stimulation of the peripheral or cranial nerves:

SEPs/SERs evaluate the pathways from nerves in the extremities through the spinal cord, to the brainstem or cerebral cortex upon stimulation of peripheral axon. Some conditions where SEPs have demonstrated usefulness include, but are not limited to the following: spinal cord trauma; subacute combined degeneration; non-traumatic spinal cord lesions, e.g., cervical spondylosis; multiple sclerosis; spinocerebellar degeneration; myoclonus; coma; and intraoperative monitoring of spinal cord, brainstem and brain sensory tracts.

SEP has an advantage in that it evaluates the entire somatosensory pathway and it is possible to distinguish between lesions located in the peripheral nerve, in the dorsal column pathway, or both. There is no need for SEP in the diagnosis of most neuropathies because the conventional nerve conduction study can identify them and no added information is obtained from SEP.

VEPs/VERs evaluate the visual nervous system pathways from the eyes to the occipital cortex of the brain. VER or VEP involves stimulation of the retina and optic nerve with a shifting checkerboard pattern or flash method. This external visual stimulus causes measurable electrical activity in neurons within the visual pathways. This is called the Visual Evoked Response (VER) and is recorded by electroencephalography electrodes located over the occiput. Using special computer techniques, the evoked responses measured over multiple trials are amplified and averaged. A characteristic waveform is produced. With pattern-shift VER, the waveform normally appears as a straight line with a single positive peak (100 msec after stimulus presentation). Abnormalities in this characteristic waveform may be seen in a variety of pathologic processes involving the optic nerve and its radiations. Pattern-shift VER is a highly sensitive means of documenting lesions in the visual system. It is especially useful when the disease process is subclinical, e.g., ophthalmologic exam is normal and patient lacks visual symptoms.

BAEPs/BAERs evaluate the auditory nerve pathways from the ears through the brain stem. A clicking sound is presented to one ear at a time. The electrical activity of this signal is recorded by electrodes on the scalp. The averaged response is displayed as a waveform that contains peaks and troughs, which correspond to various points along the hearing pathway. The time between these peaks is measured and compared to normal data. A delay in a component of the response might indicate an abnormality at specific anatomic sites in the acoustic nerve or brainstem.

Somatosensory Evoked Potentials (SEP) (CPT codes 95925, 95926, 95927) are appropriate for the following indications:
  • Spinal cord trauma.
  • Degenerative, non-traumatic spinal cord lesions.
  • Cervical spondylosis.
  • Multiple sclerosis.
  • Spinocerebellar degeneration.
  • Myoclonus.
  • Coma.
Brainstem Auditory Evoked Potentials and Responses (BAER, BAEP) (CPT codes 92585 and 92586) are appropriate when there is a history of one or more of the following conditions:
  • Asymmetric hearing loss.
  • Unilateral tinnitus.
  • Sudden hearing loss.
  • Suspected cerebellopontine angle tumor.
  • Suspected demyelinating disorder.
  • Suspected functional hearing loss.
  • Ototoxic drug therapy monitoring including chemotherapy or antibiotics.
  • Suspected auditory neuropathy.
  • Suspected acoustic neuroma.
Preoperative baseline for:
  • Posterior fossa surgery.
  • Cochlear implant.
Postoperative testing for:
  • Cochlear implant.
Visual Evoked Potentials or Responses (VEP, VER) (CPT code 95930) are appropriate for the following indications:
  • Confirm diagnosis of multiple sclerosis when clinical criteria are inconclusive.
  • Detect optic neuritis at an early, subclinical stage.
  • Evaluate diseases of the optic nerve, such as:
    • Ischemic optic neuropathy.
    • Pseudotumor cerebri.
    • Toxic amblyopias.
    • Nutritional amblyopias.
    • Neoplasms compressing the anterior visual pathways.
    • Evaluate optic nerve injury.
    • Hysterical blindness (to rule out).
  • Monitor the visual system during optic nerve (or related) surgery (monitoring of short-latency evoked potential studies).
When performing SEP/SER, depending on the clinical condition being investigated, several nerves in one extremity may have to be tested and compared with the opposite limb.
See also “Intraoperative Neurophysiological Monitoring” LCD for coverage of other CPT/HCPCS code 95920 and “Vestibular and Audiologic Function Testing” LCD for coverage of CPT/HCPCS codes 92585 and 92586.
Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
As published in CMS IOM 100-08, Section 13.5.1, to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
  • Safe and effective.
  • Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
  • Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
    • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
    • Furnished in a setting appropriate to the patient’s medical needs and condition.
    • Ordered and furnished by qualified personnel.
    • One that meets, but does not exceed, the patient’s medical need.
    • At least as beneficial as an existing and available medically appropriate alternative.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 18X, 21X, 22X, 23X, 28X, 71X, 73X, 74X, 75X, 77X, 85X
Bill Type Note: Code 73X end-dated for Medicare use March 31, 2010; code 77X effective for dates of service on or after April 1, 2010.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all the CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual IOM Pub. 100-04 Claims Processing Manual for further guidance.
092X
CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
95925©
Somatosensory testing
95926©
Somatosensory testing
95927©
Somatosensory testing
95928©
C motor evoked, uppr limbs
95929©
C motor evoked, lwr limbs
95930©
Visual evoked potential test
ICD-9-CM Codes that Support Medical Necessity
The CPT/HCPCS codes included in this policy will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 95925, 95926, 95927, 95928, 95929 and 95930:
Covered for:
036.81
Meningococcal optic neuritis
054.3
Herpetic meningoencephalitis
055.0
Postmeasles encephalitis
056.01
Encephalomyelitis due to rubella
062.0–062.5
Encephalitis
062.8–062.9
Other specified mosquito-borne viral encephalitis
063.0–063.2
Russian spring-summer (taiga) encephalitis
063.8–063.9
Tick-borne viral encephalitis
064
Viral encephalitis transmitted by other and unspecified arthropods
088.81
Lyme disease
094.0–094.2
Tabes dorsalis
094.81–094.89
Syphilitic
094.9
Neurosyphilis unspecified
170.2
Malignant neoplasm of vertebral column excluding sacrum and coccyx
192.0–192.3
Malignant neoplasm of cranial nerves
192.8–192.9
Malignant neoplasm of other specified sites of nervous system
198.3–198.4
Secondary malignant neoplasm of brain and spinal cord
225.0–225.4
Benign neoplasm of brain
225.8–225.9
Benign neoplasm of other specified sites of nervous system
237.0–237.1
Neoplasm of uncertain behavior of pituitary gland and craniopharyngeal duct
237.5–237.6
Neoplasm of uncertain behavior of brain and spinal cord
237.70–237.73
Neurofibromatosis unspecified
237.79
Other neurofibromatosis
237.9
Neoplasm of uncertain behavior of other and unspecified parts of nervous system
239.6
Neoplasm of unspecified nature of brain
300.11
Conversion disorder
324.1
Intraspinal abscess
333.0
Other degenerative diseases of the basal ganglia
333.79
Other acquired torsion dystonia
334.0–334.4
Friedreich’s ataxia
334.8–334.9
Other spinocerebellar diseases
336.0–336.3
Syringomyelia and syringobulbia
336.8–336.9
Other myelopathy
340
Multiple sclerosis
341.0–341.1
Neuromyelitis optica
341.20–341.22
Acute (transverse) myelitis nos
341.8–341.9
Other demyelinating diseases of central nervous system
342.00–342.02
Flaccid hemiplegia and hemiparesis affecting unspecified side
342.10–342.12
Spastic hemiplegia and hemiparesis affecting unspecified side
342.80–342.82
Other specified hemiplegia and hemiparesis affecting unspecified side
342.90–342.92
Unspecified hemiplegia and hemiparesis affecting unspecified side
343.0–343.4
Congenital diplegia
343.8–343.9
Other specified infantile cerebral palsy
348.2
Benign intracranial hypertension
350.1–350.2
Trigeminal neuralgia
350.8–350.9
Other specified trigeminal nerve disorders
351.0
Bell’s palsy
351.8–351.9
Other facial nerve disorders
352.0
Disorders of olfactory (1st) nerve
352.2–352.6
Disorders of other cranial nerves
352.9
Unspecified disorder of cranial nerves
353.0–353.6
Brachial plexus lesions
353.8–353.9
Other nerve root and plexus disorders
354.0–354.5
Carpal tunnel syndrome
354.8–354.9
Other mononeuritis of upper limb
355.0–355.6
Lesion of sciatic nerve
355.71
Causalgia of lower limb
355.79
Other mononeuritis of lower limb
355.8–355.9
Mononeuritis of lower limb unspecified
356.0–356.4
Hereditary peripheral neuropathy
356.8–356.9
Other specified idiopathic peripheral neuropathy
357.0–357.7
Acute infective polyneuritis
357.81–357.82
Chronic inflammatory demyelinating polyneuritis
357.89
Other inflammatory and toxic neuropathy
357.9
Unspecified inflammatory and toxic neuropathies
358.00–358.01
Myasthenia gravis
358.1–358.2
Myasthenic syndromes in diseases classified elsewhere
358.8–358.9
Other specified myoneural disorders
368.00–368.03
Amblyopia unspecified
368.10–368.16
Subjective visual disturbance unspecified
368.2
Diplopia
368.30–368.34
Binocular vision disorder unspecified
368.40–368.47
Visual field defect unspecified
368.51–368.55
Protan defect
368.59
Other color vision deficiencies
368.60–368.63
Night blindness unspecified
368.69
Other night blindness
368.8–368.9
Other specified visual disturbances
377.00–377.04
Papilledema unspecified
377.10–377.15
Optic atrophy unspecified
377.21–377.24
Drusen of optic disc
377.30–377.34
Optic neuritis unspecified
377.39
Other optic neuritis
377.41–377.42
Ischemic optic neuropathy
377.49
Other disorders of optic nerve
377.51–377.54
Disorders of optic chiasm associated with pituitary neoplasms and disorders
377.61–377.63
Disorders of other visual pathways associated with neoplasms
377.71–377.73
Disorders of visual cortex associated with neoplasms
377.75
Cortical blindness
377.9
Unspecified disorder of optic nerve and visual pathways
386.00–386.04
Meniere’s disease unspecified
386.10–386.12
Peripheral vertigo unspecified
386.19
Other peripheral vertigo
386.2
Vertigo of central origin
386.30–386.35
Labyrinthitis unspecified
386.40–386.43
Labyrinthine fistula unspecified
386.48
Labyrinthine fistula of combined sites
386.50–386.56
Labyrinthine dysfunction unspecified
386.58
Other forms and combinations of labyrinthine dysfunction
386.8–386.9
Other disorders of labyrinth
388.00–388.02
Degenerative and vascular disorders unspecified
388.10–388.12
Noise effects on inner ear unspecified
388.2
Sudden hearing loss unspecified
388.30–388.32
Tinnitus
388.40–388.44
Abnormal auditory perception unspecified
388.5
Disorders of acoustic nerve
388.60–388.61
Otorrhea unspecified
388.69
Other otorrhea
388.70–388.72
Otalgia unspecified
388.8–388.9
Other disorders of ear
389.00–389.04
Conductive hearing loss
389.08
Conductive hearing loss of combined types
389.10–389.12
Sensorineural hearing loss unspecified
389.14–389.16
Central hearing loss, bilateral
389.18
Sensorineural hearing loss of combined types, bilateral
389.20–389.22
Mixed conductive and sensorineural hearing loss
389.7–389.9
Deaf mutism not elsewhere classifiable
430–431
Subarachnoid hemorrhage
432.0–432.1
Nontraumatic extradural hemorrhage
432.9
Unspecified intracranial hemorrhage
433.00–433.01
Occlusion and stenosis of basilar artery
433.10–433.11
Occlusion and stenosis of carotid artery
433.20–433.21
Occlusion and stenosis of vertebral artery
433.30–433.31
Occlusion and stenosis of multiple and bilateral precerebral arteries
433.80–433.81
Occlusion and stenosis of other specified precerebral artery
433.90–433.91
Occlusion and stenosis of unspecified precerebral artery
434.00–434.01
Cerebral thrombosis
434.10–434.11
Cerebral embolism
434.90–434.91
Cerebral artery occlusion unspecified
435.0–435.3
Basilar artery syndrome
435.8–435.9
Other specified transient cerebral ischemias
437.3
Cerebral aneurysm nonruptured
441.00–441.03
Dissection of aorta aneurysm unspecified site
441.1–441.7
Thoracic aneurysm ruptured
441.9
Aortic aneurysm of unspecified site without rupture
721.1
Cervical spondylosis with myelopathy
721.41–721.42
Spondylosis with myelopathy thoracic region
721.91
Spondylosis of unspecified site with myelopathy
722.70–722.73
Intervertebral disc disorder with myelopathy
723.2–723.3
Other disorders of cervical region
737.0
Adolescent postural kyphosis
737.10–737.12
Kyphosis (acquired) (postural)
737.19
Other kyphosis acquired
737.20–737.22
Lordosis (acquired) (postural)
737.29
Other lordosis acquired
737.30–737.34
Scoliosis (and kyphoscoliosis) idiopathic
737.39
Other kyphoscoliosis and scoliosis
737.40–737.43
Unspecified curvature of spine associated with other conditions
737.8–737.9
Other curvatures of spine associated with other conditions
741.00–741.03
Spina bifida unspecified region with hydrocephalus
741.90–741.93
Spina bifida unspecified region without hydrocephalus
780.01
Coma
780.03
Persistent vegetative state
780.4
Dizziness and giddiness
781.2–781.4
Abnormality of gait
782.0
Disturbance of skin sensation
794.10–794.17
Nonspecific abnormal response to unspecified nerve stimulation
794.19
Other nonspecific abnormal results of function study of peripheral nervous system and special senses
806.00–806.09
Closed fracture of c1-c4 level
806.10–806.19
Open fracture of c1-c4 level
806.20–806.29
Closed fracture of t1-t6 level
806.30–806.39
Open fracture of t1-t6 level
806.4–806.5
Closed fracture of lumbar spine
806.60–806.62
Closed fracture of sacrum and coccyx
806.69
Closed fracture of sacrum and coccyx with other spinal cord injury
806.70–806.72
Open fracture of sacrum and coccyx with unspecified spinal cord injury
806.79
Open fracture of sacrum and coccyx with other spinal cord injury
806.8–806.9
Closed fracture of unspecified vertebra with spinal cord injury
850.4–850.5
Concussion with prolonged loss of consciousness without return to pre-existing conscious level
850.9
Concussion unspecified
851.00–851.06
Cortex (cerebral) contusion without open intracranial wound state of consciousness unspecified
851.09
Cortex (cerebral) contusion without open intracranial wound with concussion unspecified
851.10–851.16
Cortex (cerebral) contusion with open intracranial wound
851.19
Cortex (cerebral) contusion with open intracranial wound with concussion, unspecified
851.20–851.26
Cortex (cerebral) laceration without open intracranial wound with state of consciousness unspecified
851.29
Cortex (cerebral) laceration without open intracranial wound with concussion unspecified
851.30–851.36
Cortex (cerebral) laceration with open intracranial wound with state of consciousness unspecified
851.39
Cortex (cerebral) laceration with open intracranial wound with concussion unspecified
851.40–851.46
Cerebellar or brain stem contusion without open intracranial wound with state of consciousness unspecified
851.49
Cerebellar or brain stem contusion without open intracranial wound with concussion unspecified
851.50–851.56
Cerebellar or brain stem contusion with open intracranial wound with state of consciousness unspecified
851.59
Cerebellar or brain stem contusion with open intracranial wound with concussion unspecified
851.60–851.66
Cerebellar or brain stem laceration without open intracranial wound with state of consciousness unspecified
851.69
Cerebellar or brain stem laceration without open intracranial wound with concussion unspecified
851.70–851.76
Cerebellar or brain stem laceration with open intracranial wound with state of consciousness unspecified
851.79
Cerebellar or brain stem laceration with open intracranial wound with concussion unspecified
851.80–851.86
Other and unspecified cerebral laceration and contusion without open intracranial wound with state of consciousness unspecified
851.89
Other and unspecified cerebral laceration and contusion without open intracranial wound with concussion unspecified
851.90–851.96
Other and unspecified cerebral laceration and contusion with open intracranial wound with state of consciousness unspecified
851.99
Other and unspecified cerebral laceration and contusion with open intracranial wound with concussion unspecified
852.00–852.06
Subarachnoid hemorrhage following injury without open intracranial wound with state of consciousness unspecified
852.09
Subarachnoid hemorrhage following injury without open intracranial wound with concussion unspecified
852.10–852.16
Subarachnoid hemorrhage following injury with open intracranial wound with state of consciousness unspecified
852.19
Subarachnoid hemorrhage following injury with open intracranial wound with concussion unspecified
852.20–852.26
Subdural hemorrhage following injury without open intracranial wound with state of consciousness unspecified
852.29
Subdural hemorrhage following injury without open intracranial wound with concussion unspecified
852.30–852.36
Subdural hemorrhage following injury with open intracranial wound with state of consciousness unspecified
852.39
Subdural hemorrhage following injury with open intracranial wound with concussion unspecified
852.40–852.46
Extradural hemorrhage following injury without open intracranial wound with state of consciousness unspecified
852.49
Extradural hemorrhage following injury without open intracranial wound with concussion unspecified
852.50–852.56
Extradural hemorrhage following injury with open intracranial wound with state of consciousness unspecified
852.59
Extradural hemorrhage following injury with open intracranial wound with concussion unspecified
853.00–853.06
Other and unspecified intracranial hemorrhage following injury without open intracranial wound with state of consciousness unspecified
853.09
Other and unspecified intracranial hemorrhage following injury without open intracranial wound with concussion unspecified
853.10–853.16
Other and unspecified intracranial hemorrhage following injury with open intracranial wound with state of consciousness unspecified
853.19
Other and unspecified intracranial hemorrhage following injury with open intracranial wound with concussion unspecified
907.1–907.5
Late effect of injury to cranial nerve
950.0–950.3
Optic nerve injury
950.9
Injury to unspecified optic nerve and pathways
952.00–952.09
C1-c4 level spinal cord injury unspecified
952.10–952.19
T1-t6 level spinal cord injury unspecified
952.2–952.4
Lumbar spinal cord injury without spinal bone injury
952.8–952.9
Multiple sites of spinal cord injury without spinal bone injury
953.0–953.5
Injury to cervical nerve root and spinal plexus
953.8–953.9
Injury to multiple sites of nerve roots and spinal plexus
954.0–954.1
Injury to cervical sympathetic nerve excluding shoulder and pelvic girdles
954.8–954.9
Injury to other specified nerve(s) of trunk excluding shoulder and pelvic girdles
955.0–955.9
Injury to axillary nerve
956.0–956.5
Injury to sciatic nerve
956.8–956.9
Injury to multiple nerves of pelvic girdle and lower limb
957.0–957.1
Injury to superficial nerves of head and neck
957.8–957.9
Injury to multiple nerves in several parts
V58.62
Long-term (current) use of antibiotics
V58.69
Long-term (current) use of other medications
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.

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