Objective: To determine whether the 2013 nerve conduction study (NCS) reimbursement reduction changed Medicare utilization, payments, and patient access to Medicare physicians, we performed a retrospective analysis of Medicare data (2012-2016 fee-for-service data from the CMS Physician and Other Supplier Public Use File).

Methods: Individual billable services were identified by Healthcare Common Procedure Coding System CPT and G codes. Medicare utilization and payments were stratified by specialty and type of service (electrodiagnostic tests, including NCS and electromyography (EMG), and other neurologic procedures). We also assessed access to Medicare physicians using the annual number of unique beneficiaries receiving initial Evaluation and Management (E/M) services.

Results: We identified 676,113 Medicare providers included in all analysis years from 2012-2016 (10,599 neurologists, 5,881 physiatrists, and 659,633 other specialties). Comparing 2016 to 2012, 21.1% fewer neurologists, 28.6% fewer physiatrists, and 69.3% fewer other specialists performed NCS and 3.8% fewer neurologists, 21.7% fewer physiatrists, and 5.6% fewer other specialists performed EMG. For NCS providers in 2012, the mean number of unique Medicare beneficiaries increased for neurologists (1.2%) and physiatrists (4.8%) but decreased for other specialists (-6.5%) by 2016. Following the NCS cut, the number of providers performing autonomic and evoked potential testing increased substantially.

Conclusions: The Medicare NCS reimbursement policy resulted in a larger decrease in NCS providers than in EMG providers. Despite fewer neurologists and physiatrists performing NCS, Medicare access to these physicians for E/M services was not affected. Increased autonomic and evoked potential testing may be an unintended consequence of NCS reimbursement change.

We performed a retrospective analysis of Medicare utilization and payments at the provider level, stratified by specialty and type of service. Medicare Part B fee-for-service data were obtained from the publicly available CMS Physician and Other Supplier Public Use File (POSPUF). Individual billable services were identified by Healthcare Common Procedure Coding System (HCPCS) Level-I CPT codes and Level-II G-codes. This supplemental data details the specific codes used for our paper.