BlueCross BlueShield of Tennessee Medical Policy Manual

Surface Electromyography (sEMG)

DESCRIPTION

Surface electromyography (sEMG) is a non-invasive procedure involving the detection, recording and interpretation of the electric activity of groups of muscles at rest (i.e., static) and during activity (i.e., dynamic). The procedure is performed using a single or an array of electrodes placed on the skin surface over the muscles to be tested. Recording can also be made using a hand-held device, which is applied to the skin surface at different sites. Electrical activity is assessed by computer analysis of the frequency spectrum, amplitude, or root mean square of the electrical action potential. Surface electromyography is occasionally used as an aid to diagnose neuromuscular disorders, determine the need for surgery in individuals with low back pain, and assist in evaluating the prognosis of disorders involving muscle lesions. The technology has also been utilized to monitor the effects of rehabilitation programs and evaluate muscular function in occupational and sports programs.

Needle electromyography is an invasive procedure that records the electrical activity of individual muscles and is considered a more reliable technology.

Paraspinal sEMG, also referred to as paraspinal EMG scanning, has been explored 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 ROM, or postural disorders. The technique is performed using electrodes placed on the skin surface, with recordings made at rest, in various positions, or after a series of exercises.

Note: This policy only applies to the application of surface electromyography to the skin and does not apply to electromyography studies of the anal or urethral sphincter or needle EMG.

POLICY

Policy with similar title: Needle Electromyography (EMG)

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

There is insufficient scientific data to support the use of surface electromyography in the care management of an individual. Results that validate how sEMG aids in an individual’s overall health benefit are lacking.

SOURCES

BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2012). Paraspinal surface electromyography (EMG) to evaluate and monitor back pain (2.01.35). Retrieved April 1, 2013 from BlueWeb. (17articles and/or guidelines reviewed)

Hayes. Medical Technology Directory. (2005, December; last update March 1, 2010). Surface electromyography for evaluation of low back pain. Retrieved June 24, 2011 from http://www.Hayesinc.com/subscribers. (32 articles and/or guidelines reviewed)

Meekins, G., so, Y., Quan, D. (2008) American Association of Neuromuscular & Electrodiagnostic Medicine evidenced-based review: Use of surface EMG in the diagnosis and study of neuromuscular disorders. Muscle and Nerve, (38) 4, 1219-1224.

Pullman, S. L., Goodin, D. S., Marquinez, A. I., Tabbal, S., & Rubin, M. (2000). Clinical utility of surface EMG: Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology, (55) 2, 171-177.

U. S. Food and Drug Administration. (2004, January). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K031995. Retrieved September 28, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf3/K031995.pdf.

ORIGINAL EFFECTIVE DATE:  4/1981

MOST RECENT REVIEW DATE:  5/9/2013

ID_BA

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.

This document has been classified as public information.