95938 Insurance Policy Changes

CPT 95938, in plain terms, covers Somatosensory evoked potential study of both upper and lower limbs, stimulating peripheral nerves and recording responses along the spinal cord and brain. CPT 95938 is referenced in 7 tracked payer policy changes from Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 95938 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 95938 on AAPC

Excellus BlueCross BlueShield · Effective May 21, 2026Medium impact
Evoked Potentials 2.01.27
Policy 2.01.27 sets the indications considered medically appropriate for visual-evoked, somatosensory-evoked and auditory-evoked potentials, with a current effective date of May 21, 2026. Intra-operative neurophysiologic monitoring is considered medically appropriate during high-risk thyroid or parathyroid surgery, or during spinal, intracranial or vascular procedures, and all other indications for intra-operative neurophysiologic monitoring are considered not medically necessary. Vestibular evoked myogenic potentials, intra-operative monitoring of visual-evoked potentials, visual-evoked potential testing for glaucoma, and transcranial magnetic stimulation to elicit motor-evoked potentials are considered investigational.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Diagnostic Uses of Sensory Evoked Potentials (SEPs)
Already effective 2025-10-01: ICD-10 diagnosis codes G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2 and G35.D for multiple sclerosis were added to the code reference, and G35 was deleted 09/30/2025. Visual evoked potentials (CPT 95930) are medically necessary for diagnosis and monitoring of multiple sclerosis, and for localizing the cause of a visual field defect not explained by lesions seen on CT or MRI. Somatosensory evoked potentials (CPT 95925, 95926, 95927 and 95938) are listed as not medically necessary for several diagnoses, including amyotrophic lateral sclerosis (G12.21) and progressive spinal muscle atrophy (G12.25).
Aetna · Identified Oct 3, 2026Medium impact
Spinal Cord Stimulation (CPB 0194, reviewed 2026-09-10)
Aetna considers a trial of percutaneous dorsal column stimulation medically necessary for chronic pain from failed back surgery syndrome with low back pain and significant radicular pain, complex regional pain syndrome types 1 and 2, inoperable chronic ischemic limb pain secondary to peripheral vascular disease, or moderate to severe (5 or more on a 10-point VAS scale) chronic neuropathic pain of certain origins present for 12 or more months, when the listed criteria are met. Permanent implantation follows a trial that gives 50% or more pain relief. Cervical dorsal column stimulation for any indication other than upper extremity CRPS, dorsal column stimulation for many other conditions, and the combined use of dorsal column and dorsal root ganglion stimulation for CRPS are considered experimental, investigational or unproven. Dorsal root ganglion stimulators are covered for moderate to severe chronic intractable pain of the lower limbs in CRPS types I and II when the general spinal cord stimulator criteria are met.
Aetna · Identified Aug 14, 2026Medium impact
Evoked Potential Studies (CPB 0181, reviewed 2026-04-21)
Aetna's Clinical Policy Bulletin 0181 sets out which evoked potential studies are medically necessary and which are experimental, investigational or unproven. Somatosensory evoked potentials are medically necessary to evaluate acute anoxic encephalopathy within 3 days of the anoxic event, suspected brain death, and clinically silent brain lesions in multiple sclerosis suspects, among other listed indications. Visual evoked potentials are medically necessary to diagnose and monitor multiple sclerosis, and brainstem auditory evoked responses are medically necessary to diagnose suspected acoustic neuroma and to screen infants and children under 3 years of age for hearing loss. Cervical vestibular evoked myogenic potentials are medically necessary for vertigo from semicircular canal dehiscence syndrome after a comprehensive evaluation with inconclusive results, and for bilateral sensorineural hearing loss after cochlear implantation. Pre-operative somatosensory evoked potentials of the bilateral tibial pathways before scoliosis surgery and somatosensory evoked potentials for carpal tunnel syndrome are listed as experimental, investigational or unproven.
Blue Cross of Idaho · Identified Jun 19, 2026Medium impact
PAP516 - Intraoperative Monitoring - Typo error fixed from 95860-85870, to 95860-95870
Blue Cross of Idaho corrected a typo in PAP516 that previously listed an invalid CPT code range (95860-85870). The policy now correctly references CPT codes 95860-95870 as primary codes that can be billed with Intraoperative Neurophysiologic Monitoring (IONM) services. This correction ensures billing teams use the accurate code range for IONM claim submission.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - April 2018
Effective April 1, 2018, CAR T-cell therapy (Q2041), infliximab biosimilars (Q5103, Q5104), total artificial heart procedures (33927, 33928, 33929) and whole exome and whole genome sequencing (0036U) now require medical necessity review and prior authorization. Effective April 1, 2018, PMP22 peripheral neuropathy testing (81324, 81325, 81326) and non-cardiac SPECT brain imaging (78607) now require medical necessity review, intraoperative neurophysiologic monitoring (95925-95941 and G0453) now requires medical necessity review, and several urinary tumor marker, molecular panel and visual evoked potential services (0012M, 0013M, 0037U, 95930) are reviewed as investigational. Effective July 5, 2018, codes 43201, 43236 and 43257 are investigational for all uses, and effective April 1, 2018, bioimpedance spectroscopy (93702) and electrical or electromagnetic wound treatment codes (E0761, E0769, G0281, G0282, G0295, G0329) are removed from investigational review, while platelet-derived growth factor (S9055) is investigational and no longer requires medical necessity review or prior authorization. Pharmacy changes include a 7-day supply of short-acting opioids covered without prior authorization for opioid-naive patients effective April 15, 2018, and Neulasta Onpro added to the G-CSF policy with the same criteria as Neulasta.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - June 2018
Effective June 1, 2018, drugs for rare diseases (J0180, J0221, J1322, J1743, J1786, J3385) and breast reconstruction with DIEP or stacked flaps (S2067, S2068) now require medical necessity review and prior authorization, and coronary angiography codes 93454 through 93461 now require prior authorization. Effective June 1, 2018, intraoperative neurophysiologic monitoring codes 95940, 95941 and G0453 now require medical necessity review, while codes 95925 through 95939 and 95930 are no longer reviewed for medical necessity or investigational status. For several surgical and device services (including knee arthroscopy 29871 through 29889, lumbar decompression 63005 through 63272, sinus surgery 31254 through 31297, rhinoplasty 30400 through 30450, spinal cord stimulation 63650 through L8688, and snoring surgery 42145), medical necessity criteria now include site of service, effective June 1, 2018. Effective July 5, 2018, codes 43201, 43236 and 43257 are investigational for all uses, and revised pharmacy policies added Aimovig, Kymriah, Tremfya, Xeljanz for plaque psoriasis, and Rubraca in combination with Opdivo and Yervoy, while removing Xeljanz for ulcerative colitis.

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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 95938?

CalViva Health lists 95938 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 95938?

Community Health Plan of Imperial Valley lists 95938 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 95938?

There are 7 tracked policy changes affecting CPT 95938, including updates from Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 95938?

Payers that have issued tracked updates for CPT 95938 include: Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Aetna, Blue Cross of Idaho, Premera Blue Cross.

How do I get notified when CPT 95938 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 95938. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 95938?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Evoked Potentials 2.01.27

Diagnostic Uses of Sensory Evoked Potentials (SEPs)

Spinal Cord Stimulation (CPB 0194, reviewed 2026-09-10)

Evoked Potential Studies (CPB 0181, reviewed 2026-04-21)

PAP516 - Intraoperative Monitoring - Typo error fixed from 95860-85870, to 95860-95870

Medical Policy and Coding Updates - April 2018

Medical Policy and Coding Updates - June 2018

Prior authorization required