Needle Electromyography (EMG)
DESCRIPTION
Needle electromyography (i.e., conventional EMG) is performed to exclude, diagnose, describe and follow diseases of the peripheral nervous system and muscle, and is performed as part of an electrodiagnostic evaluation. Needle EMGs should be performed by physicians only (MD, DO, or Chiropractic Neurologist).
Needle EMG refers to the recording and study of electrical activity of muscle using a needle electrode. EMG assesses the integrity of lower motor neurons, neuromuscular junction and the muscle itself.
The needle EMG exam is the gold standard in diagnosing radiculopathies. In fact, the diagnosis of cervical, thoracic, lumbar, or lumbosacral radiculopathy cannot be made without Needle EMG (though it may be in conjunction with anatomic imaging studies such as MRI, CT, or myelography). Other diagnoses in which Needle EMG is of critical importance include:
Peripheral Nerve Entrapments (e.g. Carpal Tunnel Syndrome, Ulnar Neuropathy, Peroneal/Fibular Neuropathy)
Peripheral Nerve Injuries
Myopathies and Muscular Dystrophies
Neuromuscular Junction Disorders (e.g. Myaesthenia Gravis)
Motor Neuron Disease (e.g. Amyotrophic Lateral Sclerosis)
Generalized Peripheral Neuropathy (e.g. Diabetic Neuropathy, Alcoholic Neuropathy, Hereditary Neuropathies)
Dissociation of Nerve Conduction Studies (NCS) and the EMG into separate reports is generally inappropriate. Performance and interpretation of NCS separately from the needle EMG component of the test should be the exception (e.g. when testing an acute nerve injury or when the individual is on anticoagulants) rather than the established practice pattern.
POLICY
Needle electromyography to confirm diseases of the peripheral nervous system and muscle is considered medically necessary.
Needle electromyography in the evaluation of conditions for biofeedback purposes is considered investigational.
See also:
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
No controlled studies were found in the reviewed published literature that validated the use of needle electromyography in the evaluation or treatment of conditions for biofeedback purposes.
SOURCES
American Association of Neuromuscular & Electrodiagnostic Medicine. (2004). Recommended policy for electrodiagnostic medicine. Retrieved July 27, 2010 from http://www.aan.com/globals/axon/assets/4061.pdf.
American College of Occupational and Environmental Medicine, (2007). Low back disorders. Retrieved July 23, 2010 from http://www.guideline.gov.
BlueCross Blue Shield Association. Medical Policy Reference Manual. (2:2009). Biofeedback as a treatment of fecal incontinence. (2.01.64). Retrieved July 26, 2010 from BlueWeb. (35 articles and/or guidelines reviewed)
BlueCross Blue Shield Association. Medical Policy Reference Manual. (7:2009). Biofeedback as a treatment of urinary incontinence in adults. (2.01.27). Retrieved July 26, 2010 from BlueWeb. (29 articles and/or guidelines reviewed)
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Biofeedback therapy (NCD 30.1, p. 2-29). Ingenix.
U.S. Food and Drug Administration. (2008, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070109. Retrieved July 23, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K070109.pdf.
U.S. Food and Drug Administration. (2007, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071185. Retrieved August 9, 2010, from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K071185.pdf.
U.S. Food and Drug Administration. (2008, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K080914. Retrieved August 9, 2010, from http://www.accessdata.fda.gov/cdrh_docs/pdf8/K080914.pdf.
ORIGINAL EFFECTIVE DATE: 4/1981
MOST RECENT REVIEW DATE: 9/9/2010
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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