Coverage Policy Manual
Policy #: 1999001
Category: Medicine
Initiated: January 1993
Last Review: February 2019
  Nerve Conduction Studies (NCS), Electromyography (EMG) and Surface EMG (SEMG)

Description:
Nerve conduction studies (NCS) are used to measure action potentials resulting from peripheral nerve stimulation recordable over the nerve or from an innervated muscle.  Nerve conduction velocity measurement, one aspect of a nerve conduction study, is measured between two sites of stimulation , or between a stimulus and a recording site.  Nerve conduction studies are of two broad types:  Sensory and Motor.  Either surface or needle electrodes can be used to stimulate the nerve or record the response.  
 
Electromyography (EMG) is the study and recording of intrinsic electrical properties of skeletal muscles.  This is carried out with a needle electrode of which there are two types:
    • monopolar, or
    • concentric.  
This testing is invasive in that it requires needle insertion and adjustment at multiple sites, and at anatomically critical areas.  EMG testing relies on both the auditory and visual feedback to the electromyographer.  
 
The intensity and extent of testing with EMG and NCS are matters of clinical judgment developed after the initial pre-test evaluation and later modified during the testing procedure.  Decisions to continue, modify or conclude a test rely on a knowledge base of anatomy, physiology and neuromuscular diseases.  There is a requirement for ongoing real-time clinical evaluation, especially during the EMG examination.
 
The person performing electrodiagnostics should be appropriately trained and qualified.  They must have detailed knowledge of neuromuscular diseases and an awareness of the influence of age, temperature and body height on the results.
 
The patient's medical records must clearly document the medical necessity for the test.  Referral data containing pertinent clinical information must be available in instances where the need for a test may be questioned.  The NCS-EMG performing provider, in addition to the referring provider, is responsible for determination of the appropriateness of a study.
 
Frequency of testing is a difficult question to address.  Clinical justification, rather than an algorithm, should be dominant in these instances.  This requires clear, responsible and evidence-based documentation for any repeat study.
 
Noninvasive electrodiagnostic testing with automated and/or hand-held devices to stimulate and measure neuromuscular signals in diagnosing and evaluating systemic and entrapment neuropathies should be billed with S3905.  Examples of these devices include, but are not limited to, NC-stat, XLTek Neuropath, Neurometer and Brevio.  
 
Surface Electromyography (SEMG)
Surface electromyography (SEMG), a noninvasive procedure that records the summation of muscle electrical activity, has been investigated as a technique to evaluate the physiologic functioning of the back. In addition, this procedure has been studied as a technique to evaluate abnormal patterns of electrical activity in the paraspinal muscles in patients with back pain symptoms, such as spasm, tenderness, limited range of motion, or postural disorders.
 
SEMG devices approved by FDA include those that use a single electrode or a fixed array of multiple surface electrodes.
 
Several FDA-approved devices combine surface EMG along the spine with other types of monitors. For example, in 2007, the Insight Discovery (Fasstech, Burlington, MA) was cleared for marketing through the 510(k) process. The device contains 6 sensor types, 1 of which is surface EMG. The indications include measuring bilateral differences in surface EMG along the spine and measuring surface EMG along the spine during functional tasks. (Earlier Insight models had fewer sensor types.) FDA product code: IKN.
 
There is no specific CPT code for SEMG. One of the following nonspecific CPT codes might be used:
 
95999: Unlisted neurological or neuromuscular diagnostic procedure
97799: Unlisted physical medicine/rehabilitation service or procedure
99199: Unlisted special service, procedure, or report
 
There is a HCPCS code that is specific to surface EMG (S3900).
  

Policy/
Coverage:
Nerve Conduction Studies:
The division into axonal and demyelinating neuropathies provides a practical means of correlating electrical abnormalities with major pathophysiologic changes in the nerve.  Electrical studies can be of help in localization of an abnormality, and in distinguishing  one variety of neuropathy from another.  Such distinction has diagnostic value.  Classification of nerve injuries into neuropraxia and axonotmesis can be made on the basis of electrodiagnostic studies and this has a bearing on prognosis and treatment.
 
The Nerve Conduction Study codes refer to testing done using standard electrodiagnostic equipment.  This equipment must be capable of recording amplitude, duration and response configuration (motor NCV) and latency and sensory nerve action potential amplitudes (sensory NCV).  Examinations using portable handheld devices such as the Neural-Scan are included in a visit and should not be billed separately.  Noninvasive electrodiagnostic testing with automated and/or hand-held devices to stimulate and measure neuromuscular signals in diagnosing and evaluating systemic and entrapment neuropathies should be billed with S3905.  Examples of these devices include, but are not limited to, NC-stat, XLTek Neuropath, Neurometer  and Brevio.  
 
The number of nerves tested should be the minimum needed to establish the diagnosis.
 
The following is a list of the most common indications for NCS and the number of tests considered that meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in most cases (the first number represents Motor NCV and the second number represents Sensory NCV):
    • Carpal Tunnel (unilateral), three, four;
    • Carpal Tunnel (bilateral), four, six;
    • Radiculopathy (i.e., sciatica), three, two;
    • Mononeuropathy, three, three;
    • Polyneuropathy/Mononeuropathy Multiplex, four, four;
    • Myopathy, two, two;
    • Neuronopathy (i.e., ALS), four, two;
    • Plexopathy, four, six;
    • Neuromuscular junction disease, two, two.
    • Tarsal Tunnel Syndrome (Unilateral), four, four
    • Tarsal Tunnel Syndrome (Bilateral), five, six
    • Weakness, Fatigue, Cramps or Twitching (Focal), three, four
    • Weakness, Fatigue, Cramps or Twitching (General), four, four
    • Pain, Numbness, or Tingling (Unilateral), three, four
    • Pain, Numbness, or Tingling (Bilateral), four, six  
 
One unit of service includes all studies done on a single nerve including latency, velocity, amplitude, and response configuration with antidromic and/or orthodromic stimulation and F-wave (for those studies that include F-wave).
 
Repeat NCV testing within twelve months will be denied, unless accompanied by an explanation of medical necessity that provides clinical rationale that justifies the need for additional testing in this time period.   Undocumented repeat services will be considered not medically necessary.
 
Nerve Conduction Studies performed by Occupational or Physical Therapists meet primary coverage criteria for effectiveness and are covered if rendered by a therapist who has had special training in performing this type of testing.  Reimbursement to the therapist is limited to the technical component of the procedure only.  In order for the technical component of the test to be reimbursed to the therapist the NCS must be:
    • Ordered by a physician;
    • Performed under the supervision of a physician; and
    • Interpreted by a qualified physician with training in the interpretation of nerve conduction studies.
 
Nerve Conduction Studies (NCS) performed by Physical Therapists listed on the American Board of Physical Therapy Specialties website as a Board Certified Specialist in Clinical Electrophysiology meet primary coverage criteria for effectiveness and are covered. These qualified Physical Therapists may perform electrodiagnostic studies (EMG and NCS) (technical component) and provide physical therapy interpretations (professional component), but not make medical diagnoses based on the results of testing. (EFFECTIVE MARCH 2017)
 
Services not meeting these conditions do not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes. For contracts without primary coverage criteria, services not meeting these conditions are considered investigational.  Investigational services are contract exclusions in most member benefit certificates of coverage.
 
Screening testing for polyneuropathy (not mononeuropathies) of diabetes or end-stage-renal-disease (ESRD) is NOT covered.  Testing for the sole purpose of monitoring disease intensity or treatment efficacy in these two conditions is also not covered. Screening tests are exclusions in most member benefit certificates of coverage except for coverage based on the Patient Protection and Affordable Care Act (PPACA) screening recommendations for non-grandfathered plans and those contracts with wellness benefits (which like PPACA, covers specific screening procedures).
   
The list of nerves included in each CPT procedure code, as listed in the April 2003 CPT Assistant are:
 
Codes 95900 and 95903 involve the following nerves:
    • Upper Extremity/Cervical Plexus/Brachial Plexus Motor Nerves
      • Axillary motor nerve to the deltoid
      • Long thoracic motor nerve to the serratus anterior
      • Median nerve
        • Median motor nerve to the abductor pollicis brevis
        • Median motor nerve, anterior interosseous branch, to the flexor pollicis longus
        • Median motor nerve, anterior interosseous branch, to the pronator quadratus
        • Median motor nerve to the first lumbrical
        • Median motor nerve to the second lumbrical
      • Musculocutaneous motor nerve to the biceps brachii
      • Phrenic motor nerve to the diaphragm
      • Radial nerve
        • Radial motor nerve to the extensor carpi ulnaris
        • Radial motor nerve to the extensor digitorum communis
        • Radial motor nerve to the extensor indicis proprius
        • Radial motor nerve to the brachioradialis
      • Suprascapular nerve
        • Suprascapular motor nerve to the supraspinatus
        • Suprascapular motor nerve to the infraspinatus
      • Thoracodorsal motor nerve to the latissimus dorsi
      • Ulnar nerve
        • Ulnar motor nerve to the abductor digiti minimi
        • Ulnar motor nerve to the palmar interosseous
        • Ulnar motor nerve to the first dorsal interosseous
        • Ulnar motor nerve to the flexor carpi ulnaris
      • Other
    • Lower Extremity Motor Nerves
      • Femoral motor nerve to the quadriceps
        • Femoral motor nerve to vastus medialis
        • Femoral motor nerve to vastus lateralis
        • Femoral motor nerve to vastus intermedialis
        • Femoral motor nerve to rectus femoris.
      • Peroneal nerve
        • Peroneal motor nerve to the extensor digitorum brevis
        • Peroneal motor nerve to the peroneus brevis
        • Peroneal motor nerve to the peroneus longus
        • Peroneal motor nerve to the tibialis anterior
      • Sciatic nerve
      • Tibial nerve
        • Tibial motor nerve, inferior calcaneal branch, to the abductor digiti minimi
        • Tibial motor nerve, medial plantar branch, to the abductor hallucis
        • Tibial motor nerve, lateral plantar branch, to the flexor digiti minimi brevis
      • Other
    • Cranial nerves
      • Cranial nerve VII (facial motor nerve)
        • Facial nerve to the frontalis
        • Facial nerve to the nasalis
        • Facial nerve to the orbicularis oculi
        • Facial nerve to the orbicularis oris
      • Cranial nerve XI (spinal accessory motor nerve)
      • Other
    • Nerve Roots
      • Cervical nerve root stimulation
        • Cervical level 5 (C5)
        • Cervical level 6 (C6) Cervical level 7 (C7)
        • Cervical level 8 (C8)
      • Thoracic nerve root stimulation
        • Thoracic level 1 (T1)
        • Thoracic level 2 (T2)
        • Thoracic level 3 (T3)
        • Thoracic level 4 (T4)
        • Thoracic level 5 (T5)
        • Thoracic level 6 (T6)
        • Thoracic level 7 (T7)
        • Thoracic level 8 (T8)
        • Thoracic level 9 (T9)
        • Thoracic level 10 (T10) Thoracic level 11 (T11)
        • Thoracic level 12 (T12)
      • Lumbar nerve root stimulation
        • Lumbar level 1 (L1)
        • Lumbar level 2 (L2)
        • Lumbar level 3 (L3)
        • Lumbar level 4 (L4)
        • Lumbar level 5 (L5)
      • Sacral nerve root stimulation
        • Sacral level 1 (S1)
        • Sacral level 2 (S2)
        • Sacral level 3 (S3)
        • Sacral level 4 (S4)
 
Code 95904 involves the following nerves:
    • Upper Extremity Sensory and Mixed Nerves
      • Lateral antebrachial cutaneous sensory nerve
      • Medial antebrachial cutaneous sensory nerve
      • Medial brachial cutaneous sensory nerve
      • Median nerve
        • Median sensory nerve to the 1st digit
        • Median sensory nerve to the 2nd digit
        • Median sensory nerve to the 3rd digit
        • Median sensory nerve to the 4th digit
        • Median palmar cutaneous sensory nerve
        • Median palmar mixed nerve
      • Posterior antebrachial cutaneous sensory nerve
      • Radial sensory nerve
        • Radial sensory nerve to the base of the thumb
        • Radial sensory nerve to digit 1
      • Ulnar nerve
        • Ulnar dorsal cutaneous sensory nerve
        • Ulnar sensory nerve to the 4th digit
        • Ulnar sensory nerve to the 5th digit
        • Ulnar palmar mixed nerve
      • Intercostal sensory nerve
      • Other
    • Lower Extremity Sensory and Mixed Nerves
      • Lateral femoral cutaneous sensory nerve
      • Medial calcaneal sensory nerve
      • Medial femoral cutaneous sensory nerve
      • Peroneal nerve
        • Deep peroneal sensory nerve
        • Superficial peroneal sensory nerve, medial dorsal cutaneous branch
        • Superficial peroneal sensory nerve, intermediate dorsal cutaneous branch
      • Posterior femoral cutaneous sensory nerve
      • Saphenous nerve
      • Saphenous sensory nerve (distal technique)
      • Saphenous sensory nerve (proximal technique)
      • Sural nerve
        • Sural sensory nerve, lateral dorsal cutaneous branch
        • Sural sensory nerve
      • Tibial sensory nerve (digital nerve to toe 1)
      • Tibial sensory nerve (medial plantar nerve)
      • Tibial sensory nerve (lateral plantar nerve)
      • Pudendal sensory nerve
      • Other
 
Electromyography:
Neurogenic disorders are distinguishable from myopathic disorders by a carefully performed EMG.  Classification of nerve trauma into axonal vs. demyelinating categories, with corresponding differences in prognoses, are possible with EMG.  A list of common disorders where an EMG, in tandem with properly conducted NCS, will be helpful includes:
    • Nerve compression syndromes, including carpal tunnel syndrome and other focal compressions;
    • Radiculopathy - cervical, lumbosacral;
    • Mono/polyneuropathy - metabolic, degenerative, hereditary;
    • Myopathy - including poly- and dermatomyositis, myotonic and congenital myopathies;
    • Plexopathy - idiopathic, trauma, infiltration;
    • Neuromuscular junction disorders - myasthenia gravis.  Single fiber EMG (95872) is of special value here.  
    • At times, before Botulinum A toxin injection, for localization;
    • At times, prior to injection of phenol or other substances for nerve blocking or chemodenervation.
 
The number of limbs tested should be the minimum to establish the diagnosis.
 
Electromyography of the extremities or the cranial nerves performed by Occupational or Physical therapists meets primary coverage criteria for effectiveness and is covered.  Reimbursement to the therapist is limited to the technical component of the procedure.  In order for the technical component for the EMG to be reimbursed to the therapist the test must be:
    • Ordered by a physician;
    • Performed under the supervision of a physician; and
    • Interpreted by a qualified physician with training in the interpretation of EMGs.
 
Electromyography (EMG) performed by Physical Therapists listed on the American Board of Physical Therapy Specialties website as a Board Certified Specialist in Clinical Electrophysiology meet primary coverage criteria for effectiveness and are covered. These qualified Physical Therapists may perform electrodiagnostic studies (EMG and NCS) (technical component) and provide physical therapy interpretations (professional component), but not make medical diagnoses based on the results of testing. (EFFECTIVE MARCH 2017)
 
Services not meeting these conditions do not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.  For contracts without primary coverage criteria, services not meeting these conditions are considered investigational.  Investigational services are contract exclusions in most member benefit certificates of coverage.
 
For codes 95860-95864, only one unit of service should be billed.  This covers all muscles tested including the related paraspinal muscles and recording of the motor unit recruitment , amplitude and configurations at rest and with muscle contraction.  To bill these codes, extremity muscles innervated by three nerves or four spinal levels must be evaluated; a minimum of five muscles must have been studied.  Services not meeting these conditions do not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.  For contracts without primary coverage criteria, services not meeting these conditions are considered investigational.  Investigational services are contract exclusions in most member benefit certificates of coverage.
 
CPT 95867-95869 are used to bill a limited needle EMG of specific muscles  Theses codes will be denied if billed with more than one unit of service.  Examinations confined to distal muscles only, such as intrinsic foot or hand muscles, will be reimbursed as 95869, not 95860-95864.  Additional services do not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.  For contracts without primary coverage criteria, services not meeting these conditions are considered investigational.  Investigational services are contract exclusions in most member benefit certificates of coverage.
 
CPT 95870 can be billed at one unit per extremity when fewer than 5 muscles are examined.  This code can be used for examining muscles on the thorax or abdomen (unilateral or bilateral).  One unit may be billed for studying cervical or lumbar paraspinal muscles (unilateral or bilateral), regardless of the number of levels tested.  This code should not be billed when the paraspinal muscles corresponding to an extremity are tested and when the extremity codes 95860-95864 are also billed.  Services not meeting these conditions do not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.  For contracts without primary coverage criteria, services not meeting these conditions are considered investigational.  Investigational services are contract exclusions in most member benefit certificates of coverage.
 
Peer reviewed medical literature has not established the effectiveness of EMG by other than needle technique.   
 
EMG by other than needle technique for diagnostic purposes is not covered based on benefit certificate primary coverage criteria that there be scientific evidence of effectiveness.
 
For contracts without primary coverage criteria, EMG by other than needle technique for diagnostic purposes is considered investigational.  Investigational services are an exclusion in the member certificate of coverage.
 
CPT 51784 will be allowed for children less than 14 yrs of age.
 
Surface Electromyography (SEMG)
Paraspinal surface electromyography (SEMG) does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness as a technique to diagnose or monitor back pain.
 
For members with contracts without primary coverage criteria, paraspinal surface electromyography (SEMG) is considered investigational as a technique to diagnose or monitor back pain. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
 

Rationale:
Assessment of a diagnostic technology typically focuses on 3 parameters: 1) its technical performance; 2) diagnostic performance (sensitivity, specificity, and positive and negative predictive value) in appropriate populations of patients; and 3) demonstration that the diagnostic information can be used to improve patient outcomes.
 
Technical performance of a device is typically assessed with 2 types of studies, those that compare test measurements with a gold standard and those that compare results taken with the same device on different occasions (test-retest). The gold standard for nerve conduction testing is the electrophysiologic nerve conduction study (NCS) combined with needle electromyography (EMG).
 
In 2006, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) issued a position statement that illustrates how standardized nerve conduction studies performed independent of needle EMG studies may miss data essential for an accurate diagnosis, and how nerve disorders are far more likely to be misdiagnosed or missed completely if a practitioner without the proper skill and training is interpreting the data, making a diagnosis, and establishing a treatment plan (AANEM, 2006). The organization states that, “the standard of care in clinical practice dictates that using a predetermined or standardized battery of NCSs for all patients is inappropriate,” and concludes that, “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.”
 
Chiodo (2008) reported 150 patients, with and without back pain, ages between 55 and 79 years, who participated in a prospective, blinded, controlled study.  Needle EMG of the limb, nerve conduction studies, including peroneal F-wave and tibial H-wave, and a non-contrast lumbo-sacral spine MRI were completed.  A codified history and a physical exam were performed to differentiate symptomatic lumbar stenosis patients from asymptomatic controls.  MRI measurements did not differ significantly  with respect to extremity needle EMG findings in the entire population or in patients with clinical signs of lumbar stenosis.  In the entire population, an absent tibial H-wave corresponded to the interfacet ligament distance at L5-S1 and anterior to posterior canal size at L4-5.  In patients identified as having clinical lumbar stenosis, peroneal F-wave latency  correlated with anteroposterior canal size at L4-5 and interfacet ligament and anterior to posterior lateral recess narrowing at L5-S1.  
 
2014 Update
 
A literature search conducted through June 2014 did not reveal any new information that would prompt a change in the coverage statement.
 
September 2014 Update
 
Surface Electromyography (SEMG)
Several articles describe the use of SEMG as an aid in classifying low back pain (Humphrey, 2005; Peach, 1998; Roy, 1998). Much of this research has focused on the use of spectral analysis to assess muscle fatigability rather than how information from SEMG could enhance patient management. While SEMG may be used to objectively document muscle spasm or other muscular abnormalities, it is unclear how such objective documentation would supplant or enhance clinical evaluation, or how this information would be used to alter the treatment plan. In part, the difficulty in clinical interpretation is understanding the extent to which the SEMG abnormalities are primary or secondary.
 
There are no data regarding the impact of SEMG on the final health outcome. For example, SEMG has been proposed as a technique to differentiate muscle spasm from muscle contracture, with muscle spasm treated with relaxation therapy and contracture treated with stretching exercises. However, there are no data to validate that such treatment suggested by SEMG resulted in improved outcomes (Ellestad, 1988; Bittman, 1992).
 
A literature review of spinal muscle evaluation in low back pain patients, published in 2007, indicated that the validity of SEMG remains controversial (Demoulin, 2007). The authors note that although many studies show increased fatigability of the paraspinal muscles in patients with low back pain, it is not known whether these changes are causes or consequences of the low back pain. Also, the utility of SEMG is limited because of the inability to clearly define normal versus abnormal profiles due to factors such as a lack of normative data.
 
In a 2011 guideline from the American College of Occupational and Environmental Medicine, surface electromyography is not recommended as a technique for diagnosing low back disorders due to insufficient evidence of efficacy (ACOEM, 2014).
 
2015 Update
A literature search conducted through August  2015 did not reveal any new information that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
Technical Performance
A 2014 systematic review by Mohseni Bandpei and colleagues identified 12 studies on the test-retest reliability of paraspinal SEMG (Mohseni, 2014). Seven of the studies included only healthy individuals. The remaining 5 studies evaluated SEMG in patients with low back pain; 3 of these included a healthy control group. Overall, the studies reported that inter-rater reliability, as measured by the intra-class coefficient, varied widely from 0.26 to 0.91, with most of the values in the moderate to high range. Studies were heterogenous in terms of methodology and surface EMG parameters used. This evidence demonstrates that reliability of SEMG is at least moderate in the assessment of back muscle fatigue, but does not address the accuracy or validity of the test.
 
The evidence on paraspinal surface electromyography (SEMG) for evaluation and monitoring back pain includes a systematic review of inter-rater reliability and several studies on using findings to classify back pain. Relevant outcomes are test accuracy, test validity, symptoms, functional outcomes, quality of life, functional outcomes, and resource utilization. There are no data on the impact of SEMG on patient management or health outcomes. The evidence is insufficient to determine the effects of the technology on health outcomes.
 
2019 Update
Annual policy review completed with a literature search using the MEDLINE database through February 2019. No new literature was identified that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
Practice Guidelines and Position Statements
American College of Occupational and Environmental Medicine
Guidelines from the American College of Occupational and Environmental Medicine did not recommend surface electromyography as a technique for diagnosing low back disorders, based on insufficient evidence of efficacy (ACOEM, 2011).  

CPT/HCPCS:
51784Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique
51785Needle electromyography studies (EMG) of anal or urethral sphincter, any technique
92265Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report
95860Needle electromyography; 1 extremity with or without related paraspinal areas
95861Needle electromyography; 2 extremities with or without related paraspinal areas
95863Needle electromyography; 3 extremities with or without related paraspinal areas
95864Needle electromyography; 4 extremities with or without related paraspinal areas
95865Needle electromyography; larynx
95866Needle electromyography; hemidiaphragm
95867Needle electromyography; cranial nerve supplied muscle(s), unilateral
95868Needle electromyography; cranial nerve supplied muscles, bilateral
95869Needle electromyography; thoracic paraspinal muscles (excluding T1 or T12)
95870Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters
95872Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied
95873Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)
95874Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)
95885Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary procedure)
95886Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (List separately in addition to code for primary procedure)
95887Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure)
95907Nerve conduction studies; 1-2 studies
95908Nerve conduction studies; 3-4 studies
95909Nerve conduction studies; 5-6 studies
95910Nerve conduction studies; 7-8 studies
95911Nerve conduction studies; 9-10 studies
95912Nerve conduction studies; 11-12 studies
95913Nerve conduction studies; 13 or more studies
95933Orbicularis oculi (blink) reflex, by electrodiagnostic testing
95937Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method
S3900Surface electromyography (EMG)

References: Roy SH, Oddsson LI.(1998) Classification of paraspinal muscle impairments by surface electromyography. Phys Ther. 1998;78(8):838-851. PMID

American Assoc of Neuromuscular & Electrodiagnostic Medicine (AANEM).(2006) Proper performance and interpretation of electrodiagnostic studies. Muscle Nerve, 2006; 33(3); 436-9.

American College of Occupational and Environmental Medicine (ACOEM).(2014) Low back disorders. Occupational medicine practice guidelines: evaluation and management of common health problems and functional recovery in workers. www.guideline.gov. Accessed August, 2014.

American College of Occupational and Environmental Medicine.(2011) Low back disorders, evaluation and management of common health problems and functional recovery in workers. 3rd ed. Elk Grove Village, IL: ACOEM; 2011.

Bittman B, Cram JR.(1992) Surface electromyography: an electrophysiologic alternative in pain management. Presented at the American Pain Society; 1992; Illinois.

Chiodo A, Haig AJ, et al.(2008) Magnetic resonance imaging vs. electrodiagnostic root compromise in lumbar spinal stenosis: a masked controlled study. Am J Phys Med Rehabil, 2008; 87(10):789-97.

Demoulin C, Crielaard JM, Vanderthommen M.(2007) Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine. 2007;74(1):9-13.

Diabetes Control and Complications Trial (DCCT) Research Group.(1993) The Effects of Intensive Treatment of Diabetes on the Development and Progression of Long Term Complications in Insulin Dependent Diabetes Mellitus. NEJM 1993; 329:977-86.

Ellestad SM, Nagle RV, Boesler DR, et al.(1988) Electromyographic and skin resistance responses to osteopathic manipulative treatment for low-back pain. J Am Osteopath Assoc. 1988;88(8):991-997.

Ellestad SM, Nagle RV, Boesler DR, et al.(1988) Electromyographic and skin resistance responses to osteopathic manipulative treatment for low-back pain. J Am Osteopath Assoc. 1988;88(8):991-997.

Humphrey AR, Nargol AV, Jones AP, et al.(2005) The value of electromyography of the lumbar paraspinal muscles in discriminating between chronic-low-back-pain sufferers and normal subjects. Eur Spine J. 2005;14(2):175-184. PMID

Hung CC, Shen TW, Liang CC, et al.(2014) Using surface electromyography (SEMG) to classify low back pain based on lifting capacity evaluation with principal component analysis neural network method Conf Proc IEEE Eng Med Biol Soc. 2014;2014:18-21. PMID 25569886

Laboratory Tests in End-Stage Renal Disease Patients Undergoing Dialysis. AHCPR Pub #94-0053; Health Technology Assessment Publication #2 1994.

Mohseni Bandpei MA, Rahmani N, Majdoleslam B, et al.(2014) Reliability of surface electromyography in the assessment of paraspinal muscle fatigue: an updated systematic review. J Manipulative Physiol Ther. Sep 2014;37(7):510-521. PMID 25204717

Nathan DM.(1996) The Pathophysiology of Diabetic Complications: How Much does the Glucose Hypothesis Explain. Am Int Med 1996; 124:86-9.

Peach JP, McGill SM.(1998) Classification of low back pain with the use of spectral electromyogram parameters. Spine. 1998;23(10):1117-1123. PMID

Van Damme B, Stevens V, Perneel C, et al.(2014) A surface electromyography based objective method to identify patients with nonspecific chronic low back pain, presenting a flexion related movement control impairment. J Electromyogr Kinesiol. Dec 2014;24(6):954-964. PMID 25304196


Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2019 American Medical Association.