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MA07.050m, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
Act
by Sep 22, 2025
Effective date
Sep 22, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA07.050n (effective 09/22/2025) expands coverage for electrodiagnostic studies by removing two "Not Medically Necessary" restrictions: pattern-setting limited limb EMG for radiculopathies and portable hand-held/point-of-care nerve conduction devices. Additionally, psychophysical measurements are now designated as Not Medically Necessary, and Visual Evoked Potentials (VEP) and Brainstem Auditory Evoked Potentials (BAEP) have been added as medically necessary services.
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What to do
by Sep 22, 2025 · 7 steps
01Billing team must update system edits to ALLOW claims for pattern-setting limited limb EMG (CPT 95860, 95861, 95863, 95864) when billed with radiculopathy diagnoses (ICD-10 codes such as M54.1x, M54.2x, M54.4x) — these are no longer denied as not medically necessary.
02REMOVE blocking edits for portable hand-held or automated point-of-care nerve conduction studies; update billing software to accept these claims when clinically appropriate.
03ADD CPT codes for VEP and BAEP studies (specific codes should be verified in Attachment B of the full policy) to the medically necessary code list in billing system.
04UPDATE system to DENY or flag claims for psychophysical measurements (electrical, vibratory, or thermal perception testing) — these are now classified as Not Medically Necessary.
05Providers should be notified via bulletin that radiculopathy EMG claims previously denied as unnecessary will now be processed.
06Failure to update system rules may result in delayed processing or incorrect denials of previously restricted procedures.
07Reference Attachment B of MA07.050n for complete diagnosis code mappings.
Codes mentioned
9586095861958639586495867958689586995865S3900G0255J38.01J38.02R06.02R13.12R13.13R13.14R13.19R49.0R49.8
Original notice
MA07.050m, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →07.03.09w, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic StudiesMediumEffective Sep 22, 2025 · Medical PolicyMA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic StudiesLowEffective Oct 1, 2025 · Medical PolicyMA07.050n, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic StudiesMediumEffective Oct 1, 2025 · Medical Policy07.03.09x, Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic StudiesLowEffective Oct 1, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list