EMG/NCS Codes (California)

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EMG/NCS Codes (California)

Postby 4_TSMITH on Fri Jul 27, 2012 10:44 am

Are the codes 95885,95886 and 95887 valid codes for workers compensation claims?
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Re: EMG/NCS Codes (California) (California)

Postby jonbrissman on Sun Jul 29, 2012 8:07 am

If you are asking whether the CPT codes are listed in the Official Medical Fee Schedule, the answer is no (but you probably knew that).

The absence of a CPT code from the OMFS does not mean that the procedure is invalid for WC. The OMFS Committee in 1997 and 1998 selected the CPT codes that were most likely to be used in WC to be included in the OMFS, but medicine has evolved since then and the OMFS has not been updated. Dozens of currently-used CPT codes are not represented in the OMFS.

CPTs 95885, 95886, and 95887 are valid CPT codes promulgated by the AMA. You can use the Medicare Physician Fee Schedule (http://www.cms.gov/apps/physician-fee-s ... teria.aspx) to search for the Medicare reimbursement. Assuming that there are no UR, MPN, or other liability issues, I suggest that you pay 120% of the Medicare rate.

Don't use a bill review service that recommends zero for a CPT code because it is not in the OMFS -- it will just cause lien litigation and increase your costs, and in the end you'll still have liability for the charges.

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