Does R94.131 require prior authorization?

No, R94.131 does not require prior authorization (high confidence). Covered without prior authorization.

`R94.131`, Abnormal electromyogram [EMG]

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

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.

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

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