Skin biopsy with epidermal nerve fiber density measurement for the diagnosis of small fiber neuropathy may be considered medically necessary when all of the following conditions are met:
Individual presents with symptoms of painful sensory neuropathy; AND
There is no history of a disorder known to predispose to painful neuropathy (eg, diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy); AND
Physical examination shows no evidence of findings consistent with large-fiber neuropathy, such as reduced or absent muscle-stretch reflexes or reduced proprioception and vibration sensation; AND
Electromyography and nerve conduction studies are normal and show no evidence of large-fiber neuropathy.
Skin biopsy with epidermal nerve fiber density measurement is investigational for all other conditions, including, but not limited to, the monitoring of disease progression or response to treatment.
Measurement of sweat gland nerve fiber density is investigational.
