CPT® code 95904 Need Urgent Help

Hi everyone,

I have a question regarding billing NCS CPT® code 95904. I billed this code with 14 units and the diagnosis used is 729.5 (limb pain) to medicare. I got a denial from medicare as CO-50 "medical necessity". I tried with another dx like 723.1 again i received denial as same. But for another pt i got paid by medicare for the same diagnosis 723.1 for 95904 with 4 units. I am a little bit confused as why medicare is denying for same diagnosis for which it paid for another patient. Does the problem araising for diagnosis used or else units billed for 95904? I don't know what is wrong in it. Can we use 14 units for 95904 for medicare? Can anyone please help me out i am having a lot of denials...


Thanks

re: CPT® code 95904 Need Urgent Help

Medical necessity for 14 is the issue. Requires communication with payer

re: CPT® code 95904 Need Urgent Help

Thanks Nancy thanks a lotttttt........

One more thing nancy, Does medicare pay for 14 units of 95904, Is there any rule that mcr pays only 10units per patient per year for 95904

re: CPT® code 95904 Need Urgent Help

This will fall out of usual utilization and will require documentation. 6 should be no problem, over that and they will probably deny.
http://www.medicarenhic.com/pa/policies/Nerve%20Conduction%20Studies%20(NCS)-Electromyography%20(EMG)%20(L26869).pdf

re: CPT® code 95904 Need Urgent Help

Thank Nancy

re: CPT® code 95904 Need Urgent Help

you are welcome
Nancy