Somatosensory Testing

LCD Information Document Information Source LCD ID N/A LCD ID L35906 Original ICD-9 LCD ID Not Applicable LCD Title Somatosensory Testing Proposed LCD in Comment Period N/A Source Proposed LCD DL35906 Opens in a new window Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 03/26/2026 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date 05/17/2015 CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. 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Issue Issue Description This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.Unless otherwise specified, italicized text represents quotation from one or more of thefollowing CMS sources:Title XVIII of the Social Security Act (SSA):Section 1862(a)(1)(A) excludes expenses incurred for items or services which are notreasonable and necessary for the diagnosis or treatment of illness or injury or to improve thefunctioning of a malformed body member.Section 1833(e) prohibits Medicare payment for any claim which lacks the necessaryinformation to process the claim.Code of Federal Regulations:42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specificmedical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).CMS Publications:CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15:80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic TestsCMS Publication 100-03, Medicare National Coverage Determinations Manual,Chapter 1, Part 2:160.23 Sensory Nerve Conduction Threshold Tests (sNCTs)CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 23:10.1-10.1.7 ICD-9-CM Coding for Diagnostic Tests Coverage Indications, Limitations, and/or Medical Necessity existing knowledge of the anatomic structures and neurophysiologic events underlying the generation of evoked potentials; the influences of stimulus parameters and other experimental variables on the responses that are recorded; relevant normative data and statistics; and the clinical significance and pathologic correlates of dysfunctional neural pathways demonstrated by evoked potential alterations. It is anticipated only allopathic or osteopathic physicians will have the necessary training to meet these requirements. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A