Does G0255 require prior authorization?

No, G0255 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for G0255?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0255`, Current perception threshold/sensory nerve conduction test, (snct) per limb,

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The clinical history from the referral source must indicate the need for testing and the medical record must contain pertinent clinical information available for review upon request.
If an E/M service is separately billable, the medical record must document medical necessity for the separate E/M and the CPT must be billed with modifier 25.
When testing exceeds the reasonable maximum number of studies listed in the policy table, the physician must provide supplementary documentation justifying the additional testing.
Documentation must support the medical necessity of testing an asymptomatic contralateral limb when used to establish normative values.
When repetitive stimulation neuromuscular junction testing (CPT 95937) is performed, the physician's report must document characteristics of the test including the rate of repetition of stimulation and timing of post-exercise or high-frequency stimulus measurements.
For CPT 95905 use in carpal tunnel patients, the beneficiary's diagnosis must be coded as G56.01, G56.02, or G56.03 and records should support high pre-test probability for carpal tunnel syndrome.

Key Coverage Criteria

Nerve conduction studies (CPT 95907-95913) and/or needle electromyography (CPT 95860-95864, 95867-95872, 95885-95887) are covered when medically necessary to evaluate Carpal Tunnel Syndrome (unilateral).
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate Carpal Tunnel Syndrome (bilateral).
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate radiculopathy.
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate mononeuropathy.
Nerve conduction studies and/or needle EMG are covered when medically necessary to evaluate polyneuropathy or mononeuropathy multiplex.
Needle EMG and nerve conduction studies are covered when medically necessary to evaluate myopathy.

20 Active Policies

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

NORIDIAN-JE-L36524, Nerve Conduction Studies and Electromyography

NORIDIAN-JF-L36524, Nerve Conduction Studies and Electromyography

PALMETTO-JJ-L35048, Nerve Conduction Studies and Electromyography

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

PALMETTO-JM-L35048, Nerve Conduction Studies and Electromyography

UHC-POL-neurophysiologic-testing, Neurophysiologic Testing and Monitoring

AETNA-CPB-0357, Quantitative Sensory Testing Methods

REGENCE-MED128, Automated Point-of-Care Nerve Conduction Studies

REGENCE-MED91, Quantitative Sensory Testing

UMR-POL-UMR-neurophysiologic-testing, Neurophysiologic Testing and Monitoring

SUREST-POL-SUREST-neurophysiologic-testing, Neurophysiologic Testing and Monitoring

ANTHEM-MED.00092, Automated Nerve Conduction Testing

A54969, Billing and Coding: Nerve Conduction Studies and Electromyography

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G0255, Current perception threshold/sensory nerve conduction test, (snct) per limb,