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Coverage Policy and Recommended Guidelines for Electrodiagnostic Testing

This coverage and payment policy pertains to all State Fund and Self-insured claims.

Coverage Policy

The department or self-insurer does cover use of electrodiagnostic testing including nerve conduction studies and needle electromyography only when:

• Proper and necessary and
• Testing meets the requirements described in this policy.

Background

Electrodiagnostic testing, including nerve conduction studies (NCS) and needle electromyography (EMG), is used to identify or diagnose injury or diseases of or affecting the peripheral nervous system and skeletal muscles. NCS testing typically involves use of surface electrodes which stimulate nerves through small electric shocks and record the information back from the nerves (eg, conduction velocity, wave forms, and amplitude). This information may provide valuable diagnostic information necessary to develop or inform a treatment plan.

Needle electromyography (EMG) is an invasive procedure and is performed in a similar manner to NCS, except that stimulation and/or recording occur through fine needle electrodes inserted into or near muscle and nerve tissue.

NCS and EMG are traditionally performed by specialist physicians trained in neurophysiology programs such as physical medicine and rehabilitation (PMR) or neurology. NCS Testing may also be performed by trained technicians working under the direct supervision of physicians trained in neurophysiology. In the majority of situations, the needle EMG and the NCS examinations should be conducted and interpreted at the same time.

This policy adopts, in large part, the recommendations for the proper performance of NCS and EMG from the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), and refers to Center for Medicare and Medicaid (CMS) payment policy. The AANEM has developed coverage policy and reimbursement recommendations for insurers. The AANEM recommendations are endorsed by the American Academy of Neurology and the American Academy of Physical Medicine & Rehabilitation.

For more information:
Contact information.
See references and links to documents on electrodiagnostic medicine.