Electrodiagnostic Testing


Other diagnostic testing

Pf-NCS exam

The pf-NCS exam is a pain fiber nerve condition study that utilizes the AXON II.  It functions, operates and it even looks different than a Quantitative Sensory Test (QST) and a Neurotron (the machine used for Neurometer/CPT testing). The pf-NCS exam detects the stimulus strength causing the threshold action potential (nerve firing).  It uses a detector that allows the examiner to see the microvoltage amplitude of the action potential. Many experts and treating health providers are of the opinion that the pf-NCS test is the only test that specifically targets pain in the nerve fibers, specifically in the delta fibers.  In particular, providers that utilize this test claim that this test is the best for testing A Delta Fibers.  The Delta fibers are the best indicators where the pain is located.  As such, the pf-NCS is a great diagnostic tool in locating and pinpointing the exact nerve root that may be injured and causing pain when performed as soon after the injury as possible—during the acute phase of the injury.

In the spinal cord, A-delta fibers synapse with motor neurons in the ventral motor pathway, so firing generates voltage directly from the A-delta fibers and sub-threshold voltage from the motor fibers.  In minutes a provider can test all the major nerves and their branches in a region – 18 (9 bilateral) in the cervical and 14 (7 bilateral) in the lumbar region. The nerve(s) requiring the highest voltage to fire identifies the injured nerve(s). Once the injured nerve is identified, testing proximal and distal to a suspected site of injury easily verifies the location. Many healthcare providers claim that pf-NCS test is simply the best tool that locates and pinpoints the location where the patient is injured and where they are experiencing pain.  Some of our client even state that the pf-NCS tests are even more reliable that an EMG/NCV or MRI in locating the A Delta pain fibers.

Our law firm represents several healthcare professionals that utilize the pf-NCS exam as a diagnostic tool in their treatment of their patients. Unfortunately, there is a lot of misunderstanding, prejudice and misinformation surrounding this test.  Most of this misinformation is disseminated and proffered by Insurance carriers and their hired peer review doctors.  As a result, many arbitrators and judges have developed an aversion to this test.  The Insurance Carriers have convinced many arbitrators and judges that the pf-NCS exam is essentially a Neurometer/CPT or QST exam. That is why you need to be represented by attorneys that are experienced and knowledgeable about this specific test. Our law firm has been very successful in persuading and arguing the effectiveness and usefulness of this test.  What’s more, our law firm has provided judges and arbitrators with literature and well-reasoned legal arguments and facts demonstrating the difference between pf-NCS and other CPT/Neurometer or QST exams.  If you are experiencing trouble collecting viable claims, contact this office to discuss your legal options.   If you believe that this test is medically necessary for the course of treatment of your patient, there is no reason why you should not be reimbursed for your treatment.  Contact our law firm and we can assist you on developing a legal strategy to get your claims recovered.


Perhaps the most respected diagnostic tool a provider has. Considered the gold standard by many.  Carriers are now spending  more money and time in opposing and denying this test, because they know it is well respected as a useful tool yielding positive results. You need a skilled law firm and group of attorneys that are knowledgeable and are able to argue the medical rationale and reasons why the test was medically necessary for the particular case also assist you in rebutting with a meaningful affidavit from the.


Many providers are utilizing computerized range of motion exams. There are a number studies and literature indicating they are far superior for obtaining a more accurate reading. In fact the AMA has indicated the 3 readings rather the one reading most IME doctors.  It is important to understand the fee schedule issues that are presented with this test.  As with most diagnostic tools, insurance carriers are fighting back, because they simply do not want to pay.

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Gregory A. Goodman, P.C.

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Email: ggoodman@gganylaw.com