Neurology & Pain Management Coding Alert

Question: When reporting H-reflex studies (95934) on both sides of the body, should I append modifier -50 or report multiple units? For example, for studies on the left and right side, would I code 95934-50 or 95934 x 2?

Texas Subscriber

Answer: To report bilateral H-reflex studies appropriately, you should report a single unit of 95934 (H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle) with modifier -50 (Bilateral procedure) appended, according to the recommendations of the American Academy of Electrodiagnostic Medicine.

In addition, the national Physician Fee Schedule database assigns a "1" to column "T" ("BILAT-SURG") for 95934, indicating that modifier -50 -- rather than multiple codes and/or modifiers -LT/-RT (Left side/Right side) -- is appropriate to report a bilateral procedure for this code.

The insurer will reimburse for the second unit of 95934 at a reduced rate (generally, 50 percent of the rate of the initial study) because the set-up cost of the test is included in the first study only. This would mean that you can expect to receive about $55 for the global fee (technical and professional portions) for a bilateral
H-reflex reported as 95934-50.