Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A54095 (Billing and Coding: Nerve Conduction Studies and Electromyography) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A54095: Billing and Coding: Nerve Conduction Studies and Electromyography (Billing and Coding, effective 2025-10-01)
- Covered ICD-10-CM codes
- 1372
- 6 groups
- Non-covered ICD-10-CM codes
- 1
- Procedure codes listed
- 33
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| A05.1 | — |
| A17.83 | — |
| A17.89 | — |
| A35 | Other tetanus |
| A36.83 | — |
| A39.82 | — |
| A48.51 | — |
| A48.52 | — |
| A50.43 | — |
| A50.44 | — |
| A52.15 | — |
| A69.22 | — |
| B02.21 | — |
| B02.22 | — |
| B02.23 | — |
| B26.84 | — |
| B27.01 | — |
| B27.11 | — |
| B27.81 | — |
| B91 | Sequelae of poliomyelitis |
| C70.1 | — |
| C72.0 | — |
| C72.1 | — |
| C72.21 | — |
Procedure codes: 0106T, 0107T, 0108T, 0109T, 0110T, 51784, 51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937.
Coverage indications, limitations and medical necessity
Compliance with the provisions in this LCD may be monitored and addressed through post payment data analysis and subsequent medical review audits.
History/Background and/or General Information
Electrodiagnostic (EDX) studies are an extension of a clinical assessment for evaluation of an assortment of focal and generalized neuromuscular disorders of the peripheral nervous system and the central nervous system. Assessment of these disorders generally includes a focused neuromuscular history and physical examination, the development of a differential diagnosis and EDX studies. The EDX studies are founded on the history and physical and suspected diagnosis and are followed by an assessment of muscles and nerves using nerve conduction studies (NCSs) and needle electromyography (NEMG), and the determination of a final diagnosis. The NCSs are performed and interpreted with the NEMG on site and in real time. 1-2 NCSs may be conducted without NEMG in some situations, such as entrapment neuropathies, but this should be the exception rather than the normal practice pattern. When NCSs are conducted without NEMG, beneficial data that may be important in determining an accurate diagnosis are commonly missing. The results of the NEMG studies can frequently provide an alternative etiology or coexisting disorder in the case of a suspected disorder. 1,3
EDX studies provide beneficial information regarding location, chronicity, severity, and pathophysiology to help determine a diagnosis and monitor a disease process in response to therapy. 1
Covered Indications
• NCSs and NEMG are considered medically reasonable and necessary when they are performed and interpreted at the same time, on site, and in real time for any of the following circumstances:
• Plexopathy - including idiopathic, traumatic, inflammatory or infiltrative, radiation-induced, 1 brachial plexopathies (e.g., neuralgic amyotrophy, thoracic outlet syndrome), and lumbosacral plexopathies (e.g., diabetic, non-diabetic lumbosacral radiculoplexus neuropathy) 4
• Focal neuropathies (e.g., entrapment neuropathies or compressive lesions/syndromes such as carpal tunnel syndrome, 5-8 ulnar neuropathy, 9-10 tarsal tunnel syndrome, 11 femoral neuropathy, saphenous neuropathy, lateral femoral cutaneous neuropathy, peroneal (fibular) neuropathy, tibial neuropathies, sciatic neuropathy) 1,12-18
• Generalized neuropathies such as metabolic (e.g., diabetic, uremic), toxic, hereditary or immune-mediated 1,19-20
• Motor neuron disease (e.g., amyotrophic lateral sclerosis [ALS] or Lou Gehrig’s disease) 1,21-22
• Myopathy - including inflammatory myopathies such as polymyositis and dermatomyositis, congenital myopathies, 23 congenital and hereditary dystrophic and nondystrophic myopathies, including myotonic muscular dystrophy, acquired myopathies (drug induced myopathy associated with statins, thyroid related), metabolic myopathies (e.g., McArdle disease) 1,24
• Myotonic disorders (e.g., drug induced myotonia) 25
• Neuromuscular junction disorders (e.g., myasthenia gravis, Lambert-Eaton myasthenic syndrome, botulism) 1,26-27
• Polyneuropathies 1,28-30
• Radiculopathy - cervical, 31 thoracic or lumbosacral 1,32-33
• Spinal cord disorders 31 (i.e., myelopathy)
• Symptom-based presentations such as “pain in limb”, weakness, cramping/twitching, disturbance of skin sensation or “paresthesia” when appropriate pre-test evaluations are inconclusive, and the clinical assessment unequivocally supports the need for the study 1
• Traumatic nerve lesions, for diagnosis and prognosis 1
• Neuromuscular Junction (NMJ) Testing is considered medically reasonable and necessary for any of the following conditions:
• Botulinum toxicity 1,3
• Motor neuron disease (e.g., ALS or Lou Gehrig’s disease) 1
• Myopathy 1,34
• Myasthenia gravis 27,34-35
• Myasthenic syndrome (e.g., Lambert-Eaton myasthenic syndrome) 1,3
• NCSs when performed without NEMG are considered medically reasonable and necessary for the following situations:
• Individuals treated with anticoagulants 35-36 such as warfarin (Coumadin), rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis), edoxaban (Lixiana), clopidogrel (Plavix), ticagrelor (Brilinta), ticlopidine (Ticlid), prasugrel (Effient), varapaxar (Zontivity), dipyridamole, cilostazol (Pletal)
• Individuals with significant lymphedema in the affected extremity 36
• Individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome 3,11
• NEMG when performed without NCSs is considered medically reasonable and necessary for the following situations:
• Guidance for botulinum toxin treatment injections when it is difficult to isolate affected muscles 1,37
• Laryngeal neuropathy 38
• Constipation 39
• Fecal incontinence 39
• Lower urinary tract symptoms 40-42
• Patients with risk factors for urinary retention 40-44
• Single Fiber Electromyography (SFEMG) is considered medically reasonable and necessary for the following condition:
• Ocular myasthenia 45
• Myasthenia gravis 27,34-35
• Myasthenic syndrome (e.g., Lambert-Eaton myasthenic syndrome) 27
Limitations
The following are considered not medically reasonable and necessary:
• EDX studies where the interpretation is delayed and not completed at the time the study is performed 2, 8,46 The NCS must be performed and interpreted with the NEMG on site and in real time 1-2
• EDX studies (NCS and NEMG) not performed in accordance with the CMS regulations defined for supervision for diagnostic tests (Refer to the CMS IOM Pub 100-02, Medicare Benefit Policy Manual , Chapter 15, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests)
• Non-invasive EDX studies using portable hand-held devices or automated point of care nerve conduction monitoring systems, which are incapable of real-time waveform display and analysis 3,47-53
• Testing for polyneuropathy of diabetes in patients without clinical deficits or for the sole purpose of monitoring disease intensity or treatment efficacy 3
• Quantitative Sensory Testing (QST) (e.g., hot-cold, touch, vibration) 54-58
• NCSs accomplished with discriminatory devices that use fixed anatomic templates and computer-generated reports used as an adjunct to physical examination routinely on all patients 1
• Physiologic recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor using wearable devices with accelerometers or gyroscopes 59
• NCSs or EMG for muscle pain without the presence of other abnormalities on examination or in laboratory testing 60
• NEMG for the following situations:
• Definitive diagnosis based on paraspinal NEMG in areas with scar from past surgeries (e.g., previous laminectomies) 3
• Surface electromyography (SEMG) 3,61-63
• Macroelectromyography (macro-EMG) 3
• NEMG for isolated neck or back pain after a motor vehicle accident 60
• Studies performed beyond the reasonable maximum number of studies recommended in the American Medical Association (AMA) Current Procedural Terminology (CPT ® ) Codebook, Appendix J, Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves. These recommendations are supported by the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). 1 Additional studies may be considered upon redetermination.
Please refer to the CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, Section 160.23 Sensory Nerve Conduction Threshold Tests (sNCTs) for additional limitations.
Repeat EDX assessment may be needed in certain circumstances. The frequency for repeating EDX studies in a given patient by a given EDX provider for a given diagnosis per year can be reasonably limited. The following number of studies per 12-month period per diagnosis per provider are suitable: 1) Two studies for carpal tunnel-unilateral, carpal tunnel-bilateral, radiculopathy, mononeuropathy, polyneuropathy, myopathy, and NMJ disorders. 2) Three studies for motor neuron disease and plexopathy. These limits should not apply if the patient requires assessment by more than one EDX provider (i.e., a second opinion or an expert opinion at a tertiary care center) in a given year or if the patient requires evaluation for a second diagnosis in a given year. 1
Repeat EDX studies are rare and should not be necessary in a 12-month period in 80% of all cases. 1 Additional studies may be considered upon redetermination. In such circumstances, the rationale for the repeat study should be included in the medical record. Comparison with the previous study findings should be documented.
Provider Qualifications
Services will be considered medically reasonable and necessary when all aspects of care are within the scope of practice of the provider’s professional licensure, when performed according to the supervision requirements per state scope of practice laws, and when all procedures are performed by appropriately trained providers in the appropriate setting.
Notice : Services performed for any given diagnosis must meet all of the indications and limitations stated in this LCD, 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.
Summary of evidence (opening)
A literature search was conducted using the following key words: electrodiagnostic study; electrophysiologic study; electromyography; nerve conduction study (NCS); sensory nerve conduction study; nerve conduction velocity; quantitative sensory testing. The literature search was filtered to locate articles within 5-10 years, full-text articles, clinical trials, and systematic reviews. In general, improved health outcomes of interest include patient quality of life and function.
Guidelines and consensus statements from the AANEM have been incorporated throughout the summary of evidence. These guidelines and consensus statements offer evidence-based recommendations for the evaluation and treatment of muscle and nerve disorders in the practice of EDX medicine. These recommendations have been developed in cooperation with physicians who specialize in neuromuscular and EDX medicine. 64
EDX Studies
EDX studies are an extension of a clinical assessment for evaluation of an assortment of focal and generalized neuromuscular disorders of the peripheral nervous system and the central nervous system. EDX studies provide beneficial information regarding location, chronicity, severity, and pathophysiology to help determine a diagnosis and monitor a disease process in response to therapy. 1
The contractor cites 68 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2023-12-10
- MCD version
- 85
- Derived from
- L29547
The contractor lists one National Coverage Determination as related: NCD 160.23 Sensory Nerve Conduction Threshold Tests (sNCTs). Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Other related documents: A59566 (Response to Comments).
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Novitas Solutions, Inc. hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L35081 cover?
Electrodiagnostic (EDX) studies are an extension of a clinical assessment for evaluation of an assortment of focal and generalized neuromuscular disorders of the peripheral nervous system and the central nervous system. Assessment of these disorders generally includes a focused neuromuscular history and physical examination, the development of a differential diagnosis and EDX studies. The EDX studies are founded on… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L35081 apply to?
Novitas Solutions, Inc. applies it to Medicare claims in AR, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L35081?
The companion billing and coding article A54095 lists 1,372 ICD-10-CM codes in 6 groups that support medical necessity and 1 that do not; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L35081?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.