Nerve Fiber Density Testing

Section: Laboratory
Effective Date: May 01, 2020
Last Reviewed: March 16, 2020

Description

Skin biopsy is used to assess the density of epidermal (intraepidermal) nerve fibers using antibodies to a marker found in peripheral nerves. This procedure is proposed as an objective measure of small fiber neuropathy by identifying a reduction in the density of nerve fibers.

Criteria

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 (e.g., 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 considered experimental/investigational for all other conditions,and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Codes

 

11102

11103

11104

11105

11106

11107

88305

88314

88342

88356

Diagnosis Codes

NA

Professional Statements and Societal Positions Guidelines

NA

Links