Medicare Carrier Backs Down on Mandated Needle EMG

The Academy has prevailed in its efforts to reword the language in a draft Medicare local coverage determination, or LCD, covering certain electrodiagnostic testing methods.

In letters sent late last fall to the medical directors for CIGNA Medicare in three states -- North Carolina, Tennessee and Idaho -- AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., argued against the proposed mandate that needle electromyography, or nEMG, studies be performed on all patients who received nerve conduction studies, or NCS.

Fields told CIGNA that physicians should be allowed to use their clinical judgment as to when nEMG studies are clinically indicated.

AAFP recently learned that the final LCD (to get to the coverage determination document, choose "I accept" at the bottom of the CPT code licensing agreement you'll be presented with first) was amended to say that decisions about testing with nEMG or NCS "are matters of clinical judgment."

The change became effective Feb. 4.

Fields successfully swayed the CIGNA officials' opinions in the Academy's direction by arguing that the offending language "would effectively limit the performance of electrodiagnosis studies only to neurologists and physiatrists who primarily perform nEMG procedures."

"Family physicians pride themselves on providing high-quality, cost-effective care to patients … this proposed LCD unfairly restricts family physicians' ability to effectively diagnose and treat their Medicare patients," wrote Fields in the November letters.

He also asserted that the restrictive policy would negatively affect Medicare patients by making it more difficult and costly for them to access needed medical care.

Unfortunately, the Academy doesn't win every advocacy battle. Last September, a similar round of letters went to the Trailblazer Health Enterprises Medicare carriers in Virginia, Texas, Delaware, Maryland and the District of Columbia; however, in that final LCD (to get to the coverage determination document, choose "I accept" at the bottom of the CPT code licensing agreement you'll be presented with first), the offending language was left unchanged.