Most insurance companies follow the guidelines of the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) when it comes to reimbursing electrodiagnostic testing. The main points:
1. Testing must be done by a physician FULLY QUALIFIED to practice electrodiagnostic medicine. Which doesn't mean the internist or the chiropractor who spent money on an NC-Stat. They mean neurologists and physiatrists--most of which who are then board certified by the American Board of Electrodiagnostic Medicine (ABEM).
2. A focused neuromusculoskeletal exam and history should be performed prior to the testing to determine if it even needs to be done, again, by a physician fully qualified in electrodiagnostic medicine.
3. The AANEM states that the majority of the time, NCS done without needle EMG is not medically necessary.
So all an insurance company has to do is state it won't cover the testing unless done by a neurologist or physiatrist--most of which won't sully their hands with this device--and that a needle EMG has to be done. Barring that, all it would have to do is be sent for peer review to a neurologist or physiatrist who would state it's not medically necessary 99% of the time.
For those of you who think a Category I Code means automatic acceptance, you have no idea how the industry works. Ask the physicians who pimped for ESWT to get a Category I Code how well they're getting reimbursed for it. Most carriers still consider it experimental/investigational. Which they could do to the NC-Stat as well.
You are one of the few posters on here that understands electrodiagnostics.
That being said, the problem comes down to the Insurance companies. Plenty of insurance companies have written in their bylaws that they do not reimburse for the NC-Stat. Even Medicare states that when an NCV is performed than there must be a physician certified in Neurology/PMR/electrodiagnostics in the office.
Now here lies the problem. The person sitting at a desk all day long working for United Healthcare (or any other insurance company) is told by their boss that they must process 500 claims today. When that person is processing the claim they are not looking to see if the code that is billed (95904 or something like that) is coming from a person certified to do the test. They just process the claim and the PCP gets paid.
I know hundreds of PCP's that use NC-Stat (and other mobile NCV companies) and have NO problem what so ever getting reimbursed by insurance companies that claim that it is against their bylaws.
Very true. We put a stop to it by having all electrodiagnostic codes flagged to one area. The NC-Stat ones are fairly easy to spot since they lack a needle EMG (and the ranges of prices from as low as $300 to one as high as $9,000 also helps). Physician's credentials can easily be found online to see what their specialty is, if any.
I think though you might underestimate how many feathers NURO ruffled in the industry with their coding tactics. Many companies are probably taking these claims out of the hands of regular claims analysts and putting them through more scrutiny. Especially considering all the Mobile Electrodiagnostic testing fraud that was rampant 4-5 years ago.