2013 NCS and EMG Cuts

AAPM&R is aware of the drastic NCS and EMC reimbursement cuts that are currently impacting physiatrists. As more information becomes available, we will continue to update this Web page and share information through the various Academy communication vehicles (i.e., Connection, The Physiatrist, Member Council Info Letters, etc.).

The Latest Update
Physician Fee Schedule Final Rule Reveals Results of EMG/NCS Refinement Panel​

As many of you know, last November, the Centers for Medicare and Medicaid Services (CMS) released its CY2013 Medicare Physician Fee Schedule final rule, which included severe and drastic cuts to some of the most common physiatric procedures, Nerve Conduction Studies (NCS) and Electromyographic Studies (EMGs). Since that time, The Academy has worked with other stakeholders (AAN, AANEM, APTA) to fight these cuts by soliciting support in Congress, meeting with then CMS Director of Medicare, Jonathan Blum, and requesting and participating in a CMS refinement panel. 

The refinement panel, which took place in August, 2013, was a chance for physicians to present arguments against the revaluations of the codes that took effect on January 1, 2013. The Academy was invited to present as part of the panel as was the American Academy of Neurology (AAN) and the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). The results of the panel were announced today, November 27, 2013, as part of the CY2014 Physician Fee Schedule Final Rule. 

The results are as follows:

  • Code 95886 (EMG Extremity Add-on) will go from the 2013 final work RVU of 0.70 to 0.86 final work RVU starting on January 1, 2014
  • Code 95887 (EMG Non-extremity Add-on) will go from the 2013 final work RVU of 0.47 to 0.71 final work RVU starting on January 1, 2014
  • No changes will be made for NCS codes 95908–95913 on January 1, 2014

Although the Academy and other stakeholders were only partly successful in raising the value of the codes impacted in last year’s physician fee schedule revaluation through the refinement panel process, there still remains other avenues for advocacy in this area. The Academy is currently talking with numerous Congressional offices about the possibility of further inquiries into CMS’s decision to devalue these codes, or the possibility of legislative language to ensure fraud and abuse is addressed by going after outliers, as opposed to cutting reimbursement in a blanket fashion for all providers, including those using the tests appropriately. 

As advocacy continues around this issue, the Academy will update members periodically and initiate a Voter Voice alert should any grassroots advocacy become necessary.

What Happened and What Your Academy Is Doing to Advocate for You

On November 1, 2012, CMS published the Final Rule for the "Revisions to Payment Policies under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013."

AAPM&R analyzed the changes related to RVUs for EMGs and NCS and worked jointly with AAN and AANEM to determine next steps in addressing these issues directly with CMS and the potential impact these changes may have on the specialty of physiatry.

The Academy addressed several concerns related to the Final Rule by:

  • NCS-Update-112012.pdfProjected Cuts to Nerve Conduction Studies and EMGs for 2013
  • Drafting a Dear Colleague letter to be circulated in Congress. The letter was endorsed and sponsored by Reps. Roskam (R-IL) and Ruppersberger (D-MD) and as of December 13, 2012, was signed by 11 other members of Congress. The letter will be sent to CMS prior to the meeting scheduled for December 20.
  • Distributing a coalition letter to members of Congress signed by nearly 75 patient, provider, physician, and academic groups urging them to support this effort.
  • Sending out an Academy-wide action alert, which garnered record participation, to urge members to write their representatives to ensure their support on the Dear Colleague letter.
  • The Academy participated in meetings with the Director of the Center for Medicare, Jonathan Blum. The Academy believes that these additional meetings commissioned by CMS are a positive step as we continue to work with CMS and set the possibility of reevaluating the codes for 2014. CMS has outlined their intent of setting forth some resources designated to monitoring claims data to demonstrate the impact that the American Academy of Physical Medicine and Rehabilitation (AAPM&R), the American Academy of Neurology (AAN) the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) and the American Physical Therapy Association (APTA) described in the December 20, 2012, meeting with CMS. All stakeholders (AAPM&R, AAN, AANEM, and the APTA) will have an ongoing role in this project.
  • The Academy participated in CMS Refinement Panel for EMGs/NCS—AAPM&R was invited to attend a CMS convened meeting, called a Refinement Panel on August 20, 2013. This type of meeting is a last bid in attempting to change a Final Rule. This invitation was the result of multiple efforts from your Academy and our partnering associations in this endeavor the American Academy of Neurology and the American Association of Neuromuscular & Electrodiagnostic Medicine.
December 20, 2012, CMS Meeting Details

On December 20, 2012, the Academy participated in a meeting at CMS with the Director of the Center for Medicare, Jonathan Blum. The meeting was initiated to discuss the recent NCS/EMG cuts which were released as part of the SGR Final Rule. Dr. Barry Smith and Dr. Andrea Boon represented the Academy. The goal was to express the impact of the cuts on patients and physician practices and ask CMS for a phase-in period for the cuts to go into effect over 4 year period, during which time stakeholders such as the AAPM&R, AAN, AANEM and the APTA would work with CMS and the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC) to develop an integral plan to combat fraud and abuse and to drive down costs of over utilization.

Jonathan Blum explained that at this time the possibility of a phase-in was not a viable option due to Practice Expense (PE) components across multiple specialties. As a result, the items outlined in CMS’ Final Rule went into effect on January 1st, 2013. However, Mr. Blum has committed CMS to meeting with the group again in early 2013 to evaluate the impact of the cuts on patients and the different provider specialties these cuts will be impacting based on claims data information.