Nerve Conduction Studies and Electromyography

Section: Diagnostic Medical
Effective Date: July 01, 2018
Revised Date: January 22, 2020
Last Reviewed: January 22, 2020

Description

Electromyography (EMG) and nerve conduction studies (NCS), also collectively known asanelectrodiagnostic assessment, evaluate the electrical functioning of muscles and peripheral nerves. These tests are diagnostic aids for the evaluation of disorders of the peripheral nervous system by identifying, localizing, and characterizing electrical abnormalities in the skeletal muscles and peripheral nerves.

In addition to NCS and/or EMG, neuromuscular junction testing (repetitive nerve stimulation) may be performed and involves recording muscle responses to a series of nerve stimuli applied at differing rates, both before and after exercise or transmission of high-frequency stimuli.

Criteria

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 studies when 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 list below):
    • Motor neuron diseases; or
    • Nerve root compression; or
    • Neuromuscular junction disorders; or
    • Neuropathies, compressive; or
    • Neuropathies/myopathies, generalized and focal; or
    • Plexopathies; or
    • Traumatic nerve injuries.

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 individual 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.
  • Rapidly evolving disease in which initial electrodiagnostic testing is normal and where repeat testing might show abnormalities that will affect treatment decisions, (e.g., Guillain-Barre Syndrome); or
  • In diseases with fluctuating courses to monitor disease progress and response to therapeutic interventions (e.g. polymyositis and myasthenia gravis); or
  • Repeat evaluations after injury to monitor recovery, to help establish prognosis, and to determine the need for possible further interventions.

Electrodiagnostic assessment consisting of EMG and NVC for any other indications is considered not medically necessary.

Procedure Codes

 

95860 95861 95863 95864 95865 95866 95867
95868 95869 95870 95872 95885 95886 95887
95905 95907 95908 95909 95910 95911 95912
95913 95937

 


Electrodiagnostic assessment, consisting of electromyography, nerve conduction study, and related measures, is considered experimental/investigational (E/I) and therefore non-covered because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature:

  • Screening of asymptomatic individuals
  • These tests may include, but are not limited to:
    • A “surface” EMG (SEMG) which includes a surface paraspinal EMG.
    • Macro EMG.
    • Quantitative sensory testing (QST) which is the assessment of perceptual and/or physiological responses to pain

 

Procedure Codes

 

95999 0106T 0107T S3900

 

The following list gives specific diagnoses, according to categories of testing listed in the policy statement above for which electromyography (EMG) and nerve conduction study (NCS) generally provide useful information in confirming or excluding the diagnosis than provided by clinical examination and imaging alone. The diagnosis list is not exhaustive as there may also be less common disorders for which EMG/NCS provide useful diagnostic information:

  • Motor neuron diseases:
    • Amyotrophic lateral sclerosis; or
    • Primary lateral sclerosis; or
    • Progressive bulbar palsy; or
    • Progressive muscular atrophy; or
    • Pseudobulbar palsy; or
  • Myopathies, generalized:
    • Congenital myopathy; or
    • Dermatomyositis; or
    • Muscular dystrophies; or
    • Myotonic myopathy; or
    • Polymyositis; or
  • Nerve root compression (when physical exam and magnetic resonance imaging are inconclusive):
    • Cervical nerve root compression
    • Lumbosacral nerve root compression
    • Thoracic nerve root compression
  • Nerve root, peripheral nerve, muscle, or neuromuscular junction involvement with symptom- based presentation and pre-test evaluations are inconclusive and clinical assessment supports the need for the study forANYof the following:
    • Diplopia; or
    • Dysarthria; or
    • Impaired bowel motility; or
    • Fatigue/weakness that progresses with repetitive activity; or
    • Hyperreflexia; or
    • Impaired bowel motility; or
    • Loss of dexterity; or
    • Muscle atrophy; or
    • Muscle fasciculation; or
    • Muscle weakness; or
    • Myokymia (involuntary twitching of the eyelid muscles); or
    • Myotonia; or
    • Ptosis; or
    • Sensory deficits; or
    • Spasticity; or
    • Swallowing dysfunction; or
  • Neuromuscular junction disorders:
    • Botulinum toxicity; or
    • Lambert-Eaton myasthenic syndrome; or
    • Myasthenia gravis; or
    • Myasthenic syndrome; or
  • Neuropathies, Compressive
    • Carpal tunnel syndrome; or
    • Cubital tunnel syndrome; or
    • Other peripheral nerve entrapments; or
    • Peroneal nerve compression; or
    • Recurrent laryngeal neuropathy (RLN), (unilateral or bilateral vocal cord fold paralysis) that is greater than four (4) weeks but less than six (6) months in duration; or
    • Tarsal tunnel syndrome; or
    • Thoracic outlet syndrome; or
    • Ulnar nerve entrapment; or
  • Plexopathies:
    • Brachial plexopathy; or
    • Cervical plexopathy; or
    • Lumbosacral plexopathy; or
  • Polyneuropathies, generalized and focal:
    • Alcohol-related neuropathy; or
    • Diabetic neuropathy; or
    • Demyelinating polyneuropathies:
      • Guillain-Barré syndrome (acute); or
      • Chronic idiopathic demyelinating polyneuropathy; or
    • Hereditary neuropathies:
      • Charcot-Marie-tooth disease; or
      • Other hereditary neuropathies; or
    • Idiopathic peripheral neuropathy; or
    • Metabolic and nutritional (amyloidosis, hypothyroidism, immune, vitamin B12, or thiamine deficiency); or
    • Toxic neuropathy (e.g. vincristine, amiodarone); or
    • Uremic neuropathy; or
  • Precise muscle location for injections such as botulinum toxin, phenol, etc.
  • Radiculopathy
    • Cervical; or
    • Lumbosacral; or
    • Thoracic; or
  • Spine disorders
    • To differentiate radiculopathy from other neuropathies or non-neuropathic processes; or
    • To establish whether imaging findings are responsible for reported pain; or
    • To reconcile when pattern of pain, sensory impairment, or weakness does not match imaging findings; or
    • To document degree of axonal nerve damage in an individual with weakness; or
  • Traumatic nerve injuries.

The following table represents the recommended maximum number of electrodiagnostic studies from the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) position statement (2017). These estimates do not represent absolute maximums for all individuals; they are defined by AANEM as being sufficient to make a diagnosis in at least 90% of individuals with that particular diagnosis. Therefore, there may be a small percentage of cases that require a greater number of tests than specified.

Recommended Maximum Number of Electrodiagnostic Studies
Indication Needle EMG Nerve Conduction Studies Other Electrodiagnostic Studies
Number of Services (Tests) Motor NCS with and/or without F-wave Sensory NCS H-Reflex Neuromuscular Junction Testing (Repetitive Stimulation)
Carpal Tunnel (unilateral) 1 3 4 - -
Carpal Tunnel (bilateral) 2 4 6 - -
Radiculopathy 2 3 2 2 -
Mononeuropathy 1 3 3 2 -
Polyneuropathy/Mononeuropathy Multiplex 3 4 4 2 -
Myopathy 2 2 2 - 2
Motor Neuronopathy (e.g. ALS) 4 4 2 - 2
Plexopathy 2 4 6 2 -
Neuromuscular Junction 2 2 2 - 3
Tarsal Tunnel Syndrome (unilateral) 1 4 4 - -
Tarsal Tunnel Syndrome (bilateral) 2 5 6 - -
Weakness, Fatigue, Cramps, or Twitching (focal) 2 3 4 - 2
Weakness, Fatigue, Cramps, or Twitching (general) 4 4 4 - 2
Pain, Numbness, or Tingling (unilateral) 1 3 4 2 -
Pain, Numbness, or Tingling (bilateral) 2 4 6 2 -

Diagnosis Codes

COVERED DIAGNOSIS CODES FOR PROCEDURES CODES: 95860, 95861, 95863, 95864, 95865, 95869, 95870, 95872, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95937

A05.1 B02.21 B02.22 B02.23 E10.40 E10.41 E10.42
E10.43 E10.44 E10.49 E11.40 E11.41 E11.42 E11.43
E11.44 E11.49 E13.40 E13.41 E13.42 E13.43 E13.44
E13.49 E51.9 G04.1 G11.4 G11.8 G11.9 G12.0
G12.1 G12.20 G12.21 G12.22 G12.29 G12.8 G12.9
G50.0 G50.1 G50.8 G50.9 G51.4 G51.8 G51.9
G52.1 G52.2 G52.3 G52.7 G52.8 G52.9 G53
G54.0 G54.1 G54.2 G54.3 G54.4 G54.5 G54.6
G54.7 G54.8 G54.9 G55 G56.01 G56.02 G56.03
G56.11 G56.12 G56.13 G56.21 G56.22 G56.23 G56.31
G56.32 G56.33 G56.41 G56.42 G56.43 G56.81 G56.82
G56.83 G56.91 G56.92 G56.93 G57.01 G57.02 G57.03
G57.11 G57.12 G57.13 G57.20 G57.21 G57.22 G57.23
G57.31 G57.32 G57.33 G57.41 G57.42 G57.43 G57.51
G57.52 G57.53 G57.61 G57.62 G57.63 G57.71 G57.72
G57.73 G57.81 G57.82 G57.83 G57.91 G57.92 G57.93
G58.0 G58.7 G58.8 G58.9 G59 G60.0 G60.1
G60.2 G60.3 G61.0 G61.1 G61.81 G61.82 G62.0
G62.1 G62.2 G62.82 G62.89 G62.9 G63 G64
G65.0 G65.1 G65.2 G70.00 G70.01 G70.1 G70.2
G70.80 G70.81 G70.9 G71.00 G71.01 G71.02 G71.09
G71.11 G71.12 G71.13 G71.14 G71.19 G71.2 G71.3
G71.8 G71.9 G72.0 G72.1 G72.2 G72.3 G72.41
G72.49 G83.81 G83.82 G83.83 G83.84 G83.89 G90.09
G90.2 G90.4 G90.50 G90.511 G90.512 G90.513 G90.519
G90.521 G90.522 G90.523 G90.529 G90.59 G90.8 G90.9
J38.01 J38.02 M05.411 M05.412 M05.421 M05.422 M05.431
M05.432 M05.441 M05.442 M05.451 M05.452 M05.461 M05.462
M05.471 M05.472 M05.49 M05.511 M05.512 M05.521 M05.522
M05.531 M05.532 M05.541 M05.542 M05.551 M05.552 M05.561
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M33.00 M33.01 M33.02 M33.09 M33.10 M33.11 M33.12
M33.19 M33.20 M33.21 M33.22 M33.29 M33.90 M33.91
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M35.8 M36.0 M47.11 M47.12 M47.13 M47.14 M47.15
M47.16 M47.20 M47.21 M47.22 M47.23 M47.24 M47.25
M47.26 M47.27 M47.28 M48.061 M48.062 M51.14 M51.15
M51.16 M51.17 M54.11 M54.12 M54.13 M54.14 M54.15
M54.16 M54.17 M54.18 M54.2 M54.30 M54.31 M54.32
M54.40 M54.41 M54.42 M54.5 M62.81 M62.9 M79.10
M79.11 M79.12 M79.18 M79.601 M79.602 M79.604 M79.605
M79.621 M79.622 M79.631 M79.632 M79.641 M79.642 M79.644
M79.645 M79.651 M79.652 M79.661 M79.662 M79.671 M79.672
M79.674 M79.675 R20.0 R20.1 R20.2 R20.3 R20.8
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S22.049S S22.059A S22.059B S22.059D S22.059G S22.059K S22.059S
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S84.22XS S84.801A S84.801D S84.801S S84.802A S84.802D S84.802S
S84.809A S84.809D S84.809S S84.90XA S84.90XD S84.90XS S84.91XA
S84.91XD S84.91XS S84.92XA S84.92XD S84.92XS S94.00XA S94.00XD
S94.00XS S94.01XA S94.01XD S94.01XS S94.02XA S94.02XD S94.02XS
S94.10XA S94.10XD S94.10XS S94.11XA S94.11XD S94.11XS S94.12XA
S94.12XD S94.12XS S94.20XA S94.20XD S94.20XS S94.21XA S94.21XD
S94.21XS S94.22XA S94.22XD S94.22XS S94.30XA S94.30XD S94.30XS
S94.31XA S94.31XD S94.31XS S94.32XA S94.32XD S94.32XS S94.8X1A
S94.8X1D S94.8X1S S94.8X2A S94.8X2D S94.8X2S S94.8X9A S94.8X9D
S94.8X9S S94.90XA S94.90XD S94.90XS S94.91XA S94.91XD S94.91XS
S94.92XA S94.92XD S94.92XS

 

Professional Statements and Societal Positions Guidelines

The American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM)
Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis. If prognostic information is required on ultimate vocal fold mobility in an individual with vocal fold paralysis that is greater than four (4) weeks and less than six (6) months in duration, LEMG should be performed. LEMG may be performed to clarify treatment decisions in an individual with vocal fold immobility that is presumed to be caused by RLN (2016).

NCS performed independent of needle EMG studies may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. For this reason, it is the position of the AANEM that, except in unique situations, NCSs and needle EMG should be performed together in a study design determined by a trained neuromuscular physician. There are common diagnoses that depend on performing a needle EMG and combining the needle EMG data with the NCS data. Needle EMG studies are a necessary part of the evaluation in the diagnosis of myopathy, radiculopathy, plexopathy, disorders of the motor neuron, peripheral neuropathies and most disorders of the individual peripheral motor nerves. When the NCS is used on its own without integrating needle EMG findings or when an individual relies solely on a review of NCS data, the results can often be misleading, and important diagnoses will likely be missed. Individuals may thus be subjected to incorrect, unnecessary, and potentially harmful treatment interventions (2017).

AANEM policy statement on electrodiagnosis for distal symmetric polyneuropathy (2018):

Electrodiagnostic (EDX) studies are often very helpful in the diagnosis and management of individuals who have or are suspected to have Distal Symmetric Polyneuropathy (DSP). However, EDX studies may not be appropriate in every situation. There are five common scenarios in which EDX studies are likely to be beneficial: (1) determining primary and alternative diagnoses; (2) determining severity, duration and prognosis of disease; (3) evaluating risk of associated problems; (4) determining the effect of medications; and (5) evaluating the effect of toxic exposures.

ND Committee Review

Internal Medical Policy Committee 1-22-2020 adding diagnosis codes for weakness

Links

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.