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Electrodiagnostic Testing (CPB 0502, reviewed 2026-07-29)
Effective date
Not stated in the notice
Identified
Aug 14, 2026
Summary
Aetna covers nerve conduction studies, needle EMG, neuromuscular junction testing, late responses (H-reflex and F-wave studies) and blink reflex studies when the listed criteria are met. Aetna considers two EDX tests per year medically necessary per diagnosis, and considers one additional test per year for listed conditions when medical records document the need. Aetna considers nerve conduction studies experimental, investigational, or unproven for screening neuropathy when symptoms and physical findings are mild, primarily sensory and have a known cause.
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What to do
Action · 10 steps
01Billing team: Nerve conduction studies are considered not medically necessary without a needle EMG performed with them, unless an approvable exception is documented.
02Billing team: Bill EMG performed on the same day as NCS with CPT 95885, 95886 or 95887, which cannot be billed without an NCS code, and bill EMG performed without NCS with CPT 95860-95864 or 95870.
03Billing team: Bill each nerve tested as one unit and do not bill more than one unit for inching or studying the same nerve.
04Providers: NCS and EMG must be performed by an EDX-trained physician, or by a resident or fellow under direct supervision of one, with real-time interpretation by the EDX-trained physician.
05Technologists may perform NCS only.
06Providers: Document the relevant history and physical examination that establish the working diagnosis and need for EDX testing.
07Billing team: Submit a full EDX report that includes all EDX tests performed and the data summary tables, and forward NCS waveforms when possible.
08Billing team: When testing exceeds the Maximum Number of Studies table or two EDX tests per year per diagnosis, submit documentation justifying the additional studies.
09Providers: For cervical, thoracic or lumbar radiculopathy being considered for surgery, document persistent or progressive symptoms, at least 6 weeks of in-person formal physical therapy in the past year confirmed by PT notes or claims history, and symptoms not explained by imaging.
10Providers: Automated point-of-care NCS devices such as the NC-stat monitor and Brevio NCS monitor are listed as experimental, investigational, or unproven.
Codes mentioned
9586095861958639586495865958669586795868958699587095885958869588795905959079590895909959109591195912959139593395937G56.00G56.20G62.9G70.00G73.3
Original notice
Electrodiagnostic Testing (CPB 0502, reviewed 2026-07-29)
aetna.com · Always check the source before changing claims.
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Related policy hubs
Aetna policiesNeurologyPM&R (Physical Medicine & Rehab)Code 95860Code 95861Code 95863Code 95864Code 95865Code 95866Code 95867Code 95868Code 95869Code 95870Code 95885Code 95886Code 95887Code 95905Code 95907Code 95908Code 95909Code 95910Code 95911Code 95912Code 95913Code 95933Code 95937Code G56.00Code G56.20Code G62.9Code G70.00Code G73.3