Key Takeaway
Long Island no-fault attorney discusses PF-NCT testing defenses including fraud, coding disputes, and EMG/NCV overlap in medical necessity cases.
One of the “tests” that we see a lot of are on the run of the mill CPT, V-SNCT, PF-NCT. Of course, if you ask a Claimant “Have you ever had a CPT, V-SNCT, PF-NCT test?”, they will look at you with googly eyes. But when you show them a pen and say “you know, the test where this pen like device is connected to a computer and areas of your body are touched”, then they say, “oh I remember that.” Then you ask them, did anyone tell you the results? Nope.
This testing has three defenses. The first is the “fraud” defense. I lost that one 10 years ago, but had fun trying (Tahir v. Progressive). Nothing more will be said as the testing (even to its most vocal critics) has some valid purposes when dealing with diabetic neuropathy.
The second defense I am now seeing en vogue is the “coding” defense. Should the test be billed at 95903, 95999 or a T-3 code? Different people have different answers. My vote is for a T-3 code. This has had success at arbitrations. I would be interested to see what the Appellate Term says (when a proper foundation is adduced at either trial or on motion practice). The 95903 code appears to be from an instruction manual that the end user gets when they purchase the Axion-II machine (or its predecessors).
The new PF-NCT purports not to be entirely subjective as there is a potentiameter. Still, the patient is in control as (s) he is told to explain when they feel pain during the performance of the test, hence the subjective component. Thus, the potentiometer is supposed to objectify the subjective component of the test.
The third defense is based upon the EMG/NCV test occurring within weeks or a few months of the PF-NCT test during the patient’s treatment path. The theory, and I think it is quite valid, is pick your test. Either perform the EMG/NCV test (the so-called “gold-standard”) or the PF-NCT test, but not both. The detractors of this argument will say the the PF-NCT is more sensitive to A- fibers and C-Fibers (pain receptors) that the EMG/NCV does not address. But isn’t an EMG/NCV when appropriately performed with an examination sufficient to obtain all of the objective data? Many time, the EMG/NCV may also be overkill.
Also, if you take a pin and prick various parts of the body (waiting to elicit a response from the patient), shouldn’t this be sufficient to determine the extent of the pain fibers and to allow the clinician to accurately determine where there is sensitivity.
Related Articles
- Understanding Medical Necessity Denials: Escaping the Four Corners Rule in Long Island No-Fault Cases
- Why Conclusory Affidavits Fail: Building Strong Opposition to Medical Necessity Summary Judgment Motions
- Medical Necessity in No-Fault Insurance: Understanding the First Department’s Victory for Insurance Carriers
- A prima facie case of medical necessity?
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2014 post, New York’s no-fault fee schedules and medical necessity regulations have undergone multiple revisions that may affect the billing codes and reimbursement rates discussed for PF-NCT testing. Additionally, arbitration procedures and evidentiary standards for challenging such testing may have evolved through subsequent regulatory amendments and case law developments. Practitioners should verify current fee schedule provisions and medical necessity criteria when evaluating these testing procedures.
