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Eli's Rehab Report

Reader Question:

Nerve Conduction Studies

Published on Thu Nov 01, 2001

Question: We billed for our first nerve conduction study recently, and only received $311 of the $1,850 we billed using 95900. I cant find any cap on the number of units billable, so how can we increase our reimbursement with this procedure?

Mississippi Subscriber
 
 
Answer: Its not clear why your reimbursement was lowered so much, but because you have just started coding for nerve conduction studies, you may not be aware that Medicare will only pay for the nerve conduction study per nerve meaning if you test three sites on two nerves, you can only bill for two units of 95900. The reason you billed $1,850 but were paid only $311 may be that you billed for multiple sites tested along the same nerve. If your practice billed for each site, Medicare most likely lowered your allowable amount for this reason. Because 95900 normally pays about $50 per unit billed, they probably determined from your claim that you tested six nerves and paid you accordingly.
 
You said your carrier has no known cap on units billable for 95900. This is probably true, although most carriers list recommended unit amounts in their policies. For instance, some carriers use wording such as any claim that has a combined total of 10 or more motor nerve and sensory conduction studies should be reviewed by the medical department. This doesnt mean you should never bill more than 10 units, but it means you should be prepared to submit proof of medical necessity if you tested more than 10 nerves.

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