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Government
Commonwealth of Massachusetts
On April 10, 2002,
The Commonwealth of Massachusetts, Department of Industrial Accidents,
Administrative Judge James L. Lamothe Jr. ruled
that the Argonaut Insurance Company acting upon a claim processed
by CONCENTRA Managed Care Services, Inc., an accredited
Utilization-Review Accreditation Commission, also known as the American
Accreditation Health Care Commission, must reimburse for the
neuroselective sensory Nerve Conduction Threshold (sNCT ®)
electrodiagnostic evaluation with Current Perception Threshold (CPT®)
measures. The Order specifically states “The Insurer shall pay for the
CPT test.” A determination was made that the sNCT®/CPT
evaluation was reasonable and necessary. The physician requested the
sNCT®/CPT
evaluation because the MRI and EMG evaluations although both negative
are insensitive to small fiber sensory nerve impairments capable of
causing the patients pain that may be detected and evaluated by the sNCT®/CPT
measures.
Commonwealth of Pennsylvania
There was formal
recognition of the clinical utility of the by the Commonwealth of
Pennsylvania, Department of State, Bureau of Professional and
Occupational Affairs, State Boards of
Physical Therapy and
Occupational Therapy,
1990.
State of Texas
The State of Texas Workers' Compensation Commission
(TWCC) during development of the Spine Treatment Guideline (STG) effective
February 1, 2000, had it's Medical Review Division established a Spine
Treatment Guideline Revision Workgroup (STGRRW) composed of healthcare
providers from 10 different specialty fields and representatives from the
health insurance industry. Extensive reviews were performed of pertinent
literature, published studies and issues submitted by public cementers. The
committee and staff review concluded that the sNCT evaluation was
effective for testing for peripheral neuropathy and was an appropriate
diagnostic tool for the quantitative measure of the functional integrity of
sensory nerve fibers. The results of this
review were included in the Preamble of the amendments to the STG, published
in the Texas Register. "As a nerve conduction study, CPT
was deemed to be an appropriate diagnostic tool and was included in the List
of Diagnostic Interventions",
according to Mr. Tom Hardy, Director, Medical Review Division Director, TWCC.
This
December 17, 1999, Texas Register,
page 7, states it, "supported the efficacy for CPT testing for
peripheral neuropathy that it's not clinically detectable through sensory
nerve conduction velocity (NCV) studies. Staff's review of the
literature also supported the efficacy of CPT®
testing for the evaluation of radiculopathies and as an appropriate
diagnostic tool for the quantitative measure of the functional integrity of
sensory nerve fibers. CPT®
is considered a NCS (nerve conduction study), and is therefore included in
the STG".
Washington State
On March 1,1999, Industrial Appeals Judge Kathryn Guykema, of the Board of
Industrial Insurance Appeals, State of Washington, concluded in a hearing
related to the utility of the Neurometer®
sNCT®/CPT®
electrodiagnostic evaluation of Carpal Tunnel Syndrome: “The CPT Neurometer
provides proper and necessary medical services within the meaning of RCW
51.36.010 and it was not improper to bill using procedure code 95904
”...“and that providers are not precluded from submitting billings for
diagnostic testing using the CPT Neurometer”. (Docket
No. 98 P0056)
Japan
The Japanese government, Ministry of Health, has authorized the insurance
reimbursement for the automated neuroselective sNCT®
diagnostic evaluation since 1998. The reimbursement rate for this
electrodiagnostic evaluation is the same as for the sensory nerve conduction
velocity (NCV) procedure.
South Korea
The citizens of South Korea have universal health coverage that since 1998
has reimbursed for Neurometer®
sNCT®
diagnostic evaluations.
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Insurance
(USA - Billing Code Information)
Allstate insurance Company
On April 3, 1995 at the US District Court, Eastern District of New York,
Mario Introna vs. Allstate Insurance Company,
93-CV-2870, Judge Bartels, based upon recommendations by the expert from
the Allstate Insurance Company, determined that the correct procedure code
to be utilized for the sensory Nerve Conduction Threshold (sNCT®)
electrodiagnostic evaluation Current Perception Threshold (CPT) evaluation
be the same code that is used for the sensory nerve conduction velocity
evaluation - 95904.
Nationwide Insurance Company
In January 1998,
Nationwide Insurance Company reported that the sNCT®/CPT evaluation
"proved to have clinical applications. Independent neurologists contacted
stated CPT was a reimbursable procedure. These opinions, and discussion with
area physicians on the effectiveness if a CPT evaluation in their practices
resulted in the reimbursement of the CPT procedure"..."With the 1997 coding
revisions, CPT is being submitted under the 95904 procedure code."
Principal Life Insurance
Company
The Principal Life Insurance Company and their outside consultant, a board
certified Neurologist, conducted an evaluation of the sensory Nerve
Conduction Threshold (sNCT®) procedure and determined that it was a covered
procedure according to
letter of Aug. 21, 2002.
Associations
American
Academy of Clinical Endocrinologists (AACE)
In November.
2001, the AACE conducted one the most comprehensive scientific reviews
of the sNCT®
evaluation of diabetic neuropathy of any medical professional association
and submitted its findings to the Unites States Centers for Medicare &
Medicaid Services (CMS) in support of the clinical use of the sNCT®
evaluation as being considered, “reasonable and necessary for the Medicare
population".
The National Guideline
Clearinghouse™ (USA)
The is documentation of an independent scientific body confirming the
utility of the sNCT and documenting dysfunction of the sensory nerves.
“The National Guideline Clearinghouse™ (NGC) is a comprehensive database of
evidence-based clinical practice guidelines and related documents. NGC is an
initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S.
Department of Health and Human Services. NGC was originally created by AHRQ
in partnership with the American Medical Association and the American
Association of Health Plans (now America's Health Insurance Plans [AHIP]).
The NGC mission is to provide physicians, nurses, and other health
professionals, health care providers, health plans, integrated delivery
systems, purchasers and others an accessible mechanism for obtaining
objective, detailed information on clinical practice guidelines and to
further their dissemination, implementation and use.”
The NGC provides the following guidelines with respect to the Current
Perception Threshold (CPT) electrodiagnostic evaluation, dated July, 2005:
“Current Perception Threshold (CPT) Testing
Sub-Recommendation
Current perception threshold devices may be used for the quantitative
assessment of sensory nerve function. Alterations in sensory nerve function
may be associated with vertebral subluxation.
Rating: Established
Evidence: E, L
Categories of Evidence:
E: Expert opinion based on clinical experience, basic science rationale,
and/or individual case studies. Where appropriate, this category includes
legal opinions.
L: Literature support in the form of reliability and validity studies,
observational studies, "pre-post" studies, and/or multiple case studies.
Where appropriate, this category includes case law.”
American Clinical
Neurophysiology Society
This society, formerly the
American Encephalographic Society, conducted a
technology review of the Neurometer®
sNCT CPT electrodiagnostic evaluation in 1995.
Routine clinical use was reviewed by clinicians from Creighton University
(>10 years), Harvard Medical School (>5 years), Veterans Administration
Medical Center, New Orleans (>6 years), Internal Medicine Practice,
Layfayette, LA (>3 yrs), Neurology Practice, Ventura, CA (>8 yrs),
University of California, Los Angeles (>5 yrs). All the reviews were
highly favorable.
Legal Citations
The following list provides
examples of legal citations:
-
Herman Leblanc, Jr. vs
Aetna Life and Casualty Co., OWC#90-01163, District 5
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Kenneth Atkinson vs Ethyl Corporation, et.
al., District Court of Harris County Texas, 152nd Judicial District.
-
Lilburn Levay Fuller and Gary James Darby
vs Union Equity Cooperative Exchange, et. al.
-
Lilburn Levay Fuller vs Gulf Stream
Maritime and Aetna Casualty and Surety Co., OWC #8-91011.
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Gary James Darby vs Gulf Stream Maritime
and Aetna Casualty and Surety Co., OWC #8-91032.
-
Ruth Theirry Bird vs Jimmy D. Qualle and
Jonathon Kaizer. Okmulgee District Court, Okmulgee, Oklahoma.
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Jack L. Pope vs Hinz Trucking-a foreign
corporation & Allan Zuckert-an individual, Okmulgee District Court,
Okmulgee, Oklahoma.
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Stacy Null vs Ruben Gomez Superior Court
for the County of Ventura, California, Case #123736 (1/31/94).
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GTE vs. Wilson-Briton, before the State of
Washington Board of Industrial Insurance Appeals, Claim T579020 Docket
#924082. Proposed decision and order, re: Judith M. Wilson, July 15,
1993.
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Onamura vs Weisman, Case No.92-3169-09,
Circuit Court of the First Circuit of the State of Hawaii, Honolulu,
August, 1995.
-
Louise Jones vs Nationwide Ins. Co. /
Solomon, Docket 64834-6 T.D., Shelby County, TN. Circuit Court, October,
1997.
-
Havsy, S.L., D.O. and Pain Diagnostics and
Rehabilitation Associates, P.S., Before the Board of Industrial
Insurance Appeals State of Washington, Docket No. 98.P0056, Provider No.
55001 & 56000, Industrial Appeals Judge: Kathryn Guykema, March 1999.
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Christopher Dial and Angeline Taylor v.
Grave Rigsby, Order CCG-N002, IL, 97 M4 704, Fourth Municipal District
Circuit Court of Cook County, Judge James V. Murphy, May 24, 2000.
Aurelia Pucinski, Clerk of the Circuit Court.
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