Electrodiagnostic assessment, consisting of electromyography, nerve conduction study, and related measures, may be considered medically necessary as an adjunct to history, physical exam, and imaging studieswhen the following criteria are met:
Signs and symptoms of peripheral neuropathy and/or myopathy are present; and
Definitive diagnosis cannot be made by physical exam and imaging studies alone; and
Work-up for one or more of the following categories of disease is indicated (see Policy Guidelines section):
Compressive neuropathies
Nerve root compression
Traumatic nerve injuries
Generalized and focal neuropathies/myopathies
Plexopathies
Motor neuron diseases
Neuromuscular junction disorders.
A repeat electrodiagnostic assessment may be considered medically necessary when at least one of the following criteria has been met:
Development of new symptoms or signs suggesting a second diagnosis in a patient who has received an initial diagnosis; or
Interim progression of disease following an initial test that was inconclusive, such that a repeat test is likely to elicit additional findings; or
Unexpected change(s) in the course of disease or response to treatment, suggesting that the initial diagnosis may be incorrect and that reexamination is indicated.
Electrodiagnostic assessment, consisting of electromyography, nerve conduction study, and related measures, is considered investigational when the above criteria are not met, including but not limited to, the following situations:
Screening of asymptomatic individuals
Serial assessments to evaluate progression of disease in a patient with a previously diagnosed neuropathy or myopathy
Evaluation of treatment response in a patient with previously diagnosed neuropathy or myopathy
Evaluation of disease severity in a patient with previously diagnosed neuropathy or myopathy.
