Electrodiagnostic Testing (CPB 0502, reviewed 2026-07-29)

By July 29, 2026: (1) Billing team must update prior authorization system to enforce disease-specific criteria for EDX testing, particularly for carpal tunnel syndrome (requires sensory conduction distance 13-14 cm median nerve + comparison studies if initial normal), radiculopathy (requires 6+ weeks failed PT documented in claims), and distal symmetric polyneuropathy (requires labs or atypical findings). (2) Providers must document clinical working diagnosis, relevant H&P, and specific indication in all EDX requests. (3) Billing system must flag any NCS requests without concurrent EMG as non-approvable unless specific coagulation/anticoagulant exceptions are documented. (4) Update encounter forms and provider templates to require: confirmation of NCS performed by EDX-trained physician with real-time interpretation, evidence of failed conservative care (for radiculopathy), baseline labs (for DSP), and full EDX reports with data summary tables. (5) Train authorization staff on disease-specific approval thresholds (e.g., mild sensory-only DSP with known etiology = experimental/non-covered). Claims submitted without meeting specific criteria will be denied as not medically necessary.