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 normally performed as part of an electrodiagnostic evaluation.
Needle EMG refers to the recording and study of electrical activity of muscle using a needle electrode. EMG assesses the integrity of upper motor neurons, lower motor neurons, neuromuscular junction and the muscle itself.
The procedure is seldom diagnostic for a particular disease entity. The major use lies in differentiating between the following disease classes: primary myopathy, peripheral motor neuron disease and disease of the neuromuscular junction.
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:
ADDITIONAL INFORMATION
No controlled studies were found in the reviewed published literature that validated the use of needle electromyography in the evaluation of conditions for biofeedback purposes.
SOURCES
American Association of Neuromuscular & Electrodiagnostic Medicine. (2004). Recommended policy for electrodiagnostic medicine. American Association of Neuromuscular & Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Retrieved March 22, 2005 from http://www.aanem.org/PracticeIssues/RecPolicy/recommended_policy_1.cfm.
Arend, W. P., Armitage, J. O., Drazen, J. M., Gill, G. N., Griggs, R. C., Powell, D. W., et al. (Eds.). (2004.). Goldman: Cecil Textbook of Medicine (22nd ed., pp. 2197-2205). Philadelphia: W. B. Saunders Company.
BlueCross Blue Shield Association. Medical Policy Reference Manual. (3:2006). Biofeedback as a treatment of fecal incontinence. (2.01.64). Retrieved December 29, 2006 from BlueWeb.
BlueCross Blue Shield Association. Medical Policy Reference Manual. (4:2006). Biofeedback as a treatment of urinary incontinence in adults. (2.01.27). Retrieved December 29, 2006 from BlueWeb.
CIGNA Government Services Medicare Part B Carrier - Tennessee Local Coverage Determination. (2006, October). LCD for nerve conduction studies (NCS) electromyography (EMG) (L5789). Retrieved January 2, 2007 from http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=5789&lcd_version=30&show=all.
Goetz, C. G. (2003). Goetz: Textbook of Clinical Neurology (2nd ed., pp. 480-481). Philadelphia: Elsevier.
Goetz, C., (2007). Textbook of Clinical Neurology (3rd ed., pp. 490-494). Philadelphia: Saunders, an imprint of Elsevier Inc.
Hogan, C. J., & Degnan, G. G. (2001). An orthopedic surgeon's guide to interpreting electromyography. The American Journal of Orthopedics, 30 (10), 745-750.
National Guideline Clearinghouse. (2001). Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Clinical utility of surface EMG: report of the therapeutics and technology assessment subcommittee of the American academy of neurology. Retrieved January 2, 2007 from http://www.guidelines.gov.
U.S. Food and Drug Administration. (2008, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070109. Retrieved November 19, 2008 from http://www.fda.gov/cdrh/pdf7/K070109.pdf
Walsh, P. C., Retick, A. B., Vaughan, E. D., Wein, A. J., Kavoussi, L. R., Novick, A. C., et al (Eds). (2002). Campbell's Urology (8th ed., pp. 1037-1043). Philadelphia: W. B. Saunders Company.
ORIGINAL EFFECTIVE DATE: 4/1981
MOST RECENT REVIEW DATE: 1/8/2009
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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