Electrodiagnostic Medicine Patient Protection and Fraud Elimination Act of 2025
The Electrodiagnostic Medicine Patient Protection and Fraud Elimination Act of 2025 would tighten Medicare policy on electrodiagnostic services (nerve conduction studies and needle electromyography). It would bar payment for these services unless they are performed at a "qualified facility" that is accredited by an organization specified by the Secretary. The pay-for-service start date would be phased in: no payment for non-qualified facilities after a date determined by the Secretary, between 3 and 4 years after enactment, with an exemption for interoperative neuromonitoring. The bill also creates a framework for accrediting bodies, sets minimum facility requirements (quality programs, appropriate equipment, trained personnel, and on-site interpretation), and establishes a National Electrodiagnostic Services Advisory Committee to advise on standards and accreditation processes. The changes aim to reduce waste, fraud, and abuse and improve diagnostic reliability and patient safety, while potentially affecting access to these services outside accredited facilities during the transition.
Key Points
- 1Payment restriction timeline: Medicare would not pay for electrodiagnostic services (nerve conduction studies and needle EMG) furnished at non-qualified facilities, with an implementation window of 3 to 4 years after enactment; interoperative neuromonitoring is excluded from this prohibition.
- 2Qualified facility and accreditation: A facility must be accredited by an organization specified by the Secretary to be considered qualified. The Secretary must designate accrediting bodies within two years, ensuring there are enough organizations and that they are widely recognized.
- 3Facility requirements for accreditation: Accredited facilities must have a quality assurance/control program, use equipment capable of recording amplitude and latency for nerve conduction studies, and provide real-time waveform display/analysis for needle EMG. Needle EMG providers must have at least 3 months of formal electrodiagnostic training in a residency/fellowship or as specified in CFR rules.
- 4On-site interpretation: The results must be interpreted on-site at the time of the procedure, by the clinician who performed the test for needle EMG, and by the tester or supervisor for nerve conduction studies.
- 5Regulations and oversight: The Secretary must finalize regulations within one year detailing the process for accrediting organizations, reaccreditation cycles, and withdrawal of accreditation, plus effects on facilities if accreditation is withdrawn.
- 6Advisory committee: Establishment of the National Electrodiagnostic Services Advisory Committee (9-11 members) to recommend requirements, regulations, and accreditation decisions. The committee must include a physician experienced in electrodiagnostic services, a certified clinical electrophysiology physical therapist, other health care practitioners, and at least one patient representative, and it must meet at least twice per year.