Electromyography (EMG)

POLICY NUMBER

L.2.01.417

DESCRIPTION

Electromyogram (EMG) is a graphic record of the contraction of a muscle as a result of electrical stimulation. Electromyography is the preparation, study of, and interpretation of electromyograms.

There are two types of EMGs; invasive and surface. An invasive (needle) EMG is the standard diagnostic test regarding the investigation of radiculopathy.

Non-invasive surface electromyography (SEMG) is the procedure chiropractors are utilizing, although it is generally coded as an EMG just as physicians code their EMGs.

POLICY

Miss. Code Ann. section 73-6-1 (Supp. 1992), provides, in paragraph (5) thereof, that chiropractors shall not use venipuncture, capillary puncture, acupuncture or any other technique which is invasive of the human body either by penetrating the skin or through any of the orifices of the body or through the use of colonics. Therefore, invasive EMGs are not within the scope of practice of a chiropractor and should be denied as same. These can only be performed by physicians, primarily neurologists because their expertise is in this area.

Non-invasive surface electromyography (SEMG) is the procedure chiropractors are utilizing, although it is coded as an EMG just as physicians code their EMGs. SEMG has not been scientifically demonstrated as a useful tool in the clinical evaluation of radiculopathy. All this machine does is show surface electrical activity within the muscle. It does not help in the management or diagnosis, but can cause misdiagnosis.

Though the utilization of surface paraspinal electromyography may be within the legislatively defined scope of practice regarding chiropractors in the state of Mississippi. The device itself has not been shown, at this time, to be a reliable medically necessary diagnostic procedure regarding diagnosis, management or prognosis of muscular, musculoligamentous, and/or neuromusculoskeletal disorders.

In conclusion, payment of benefits to chiropractors for invasive EMGs should be denied on the basis that some are not within the scope of a chiropractors license and payment of benefits for non-invasive, i.e., surface EMGs, should be denied on the basis that some are not medically necessary, and, in addition, thereto, are investigational in nature.

Electromyogram (EMG) is generally accepted medical practice. For diagnostic purposes, benefits are eligible for coverage for the following:

• Spinal cord injury

• Herniated nucleus pulposus (HNP) (ruptured disc)

• Thoracic outlet syndrome

• Nerve syndrome

• Back and extremity pain

• Peripheral neuritis

• Tensilon Test for Myasthenia gravis

When Electromyogram (EMG) is used for treatment, benefits are eligible for coverage for the following:

• Pathological muscle abnormalities for spasticity

• Incapacitating muscle spasm

• Semiparesis (paralysis)

POLICY EXCEPTIONS

None

POLICY GUIDELINES

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Mental Health Disorders, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:

A.  consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and

B.  appropriate with regard to standards of good medical practice; and

C.  not solely for the convenience of the Member, his or her Provider; and

D.  the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.

For the definition of medical necessity, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.

Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.

POLICY HISTORY

7/1993: Approved by Medical Policy Advisory Committee (MPAC), CPT code 97118 added

4/5/2001: Policy reviewed; Managed Care Requirements deleted

2/7/2002: Investigational definition added

4/26/2002: Type of Service and Place of Service deleted

8/10/2005: Code Reference section updated, CPT code 97118 deleted, CPT code 95860, 95861, 95863, 95864, 95867, 95868, 95869, 95870, 95858 added covered codes, ICD-9 procedure code 93.08 added covered codes, ICD-9 diagnosis code 334.1, 337.9, 342.00, 342.01, 342.02, 342.10, 342.11, 342.12, 342.80, 342.81, 342.82, 342.90, 342.91, 342.92, 343.1, 343.3, 343.4, 353.0, 354.0, 354.2, 354.8, 355.1, 355.5, 355.6, 355.9, 356.0, 356.9, 722.0, 722.10, 722.2, 723.1, 723.2, 723.3, 723.4, 723.8, 724.1, 724.2, 724.3, 724.5, 724.9, 729.2, 729.5, 742.8, 742.9, 781.0, 806.00, 806.04, 806.05, 806.09, 806.10, 806.14, 806.15, 806.19, 806.20, 806.24, 806.25, 806.29, 806.30, 806.34, 806.35, 806.39, 806.4, 806.5, 806.60, 806.61, 806.62, 806.69, 806.70, 806.71, 806.72, 806.79, 806.8, 806.9, 907.2, 952.00, 952.01, 952.02, 952.03, 952.04, 952.05, 952.06, 952.07, 952.08, 952.09, 952.10, 952.11, 952.12, 952.13, 952.14, 952.15, 952.16, 952.17, 952.18, 952.19, 952.2, 952.3, 952.4, 952.8, 952.9 added covered codes, non-covered codes table added, CPT code 96002, 96003, 97014, 97032 added non-covered codes, HCPCS E0746, S3900 added non-covered codes

03/22/2006: Coding updated. CPT4 2006 revisions added to policy

10/16/2006: Policy reviewed, no changes

08/28/2015: Code Reference section updated for ICD-10. Removed deleted CPT code 95858.

06/06/2016: Policy number L.2.01.417 added. Policy Guidelines updated to add medically necessary and investigative definitions.

02/07/2019: Code Reference section updated to add CPT code 96004.

01/24/2023: Policy reviewed. Policy statements unchanged. Policy Guidelines updated to change "Nervous/Mental Conditions" to "Mental Health Disorders" and "Medically Necessary" to "medical necessity."

10/18/2023: Policy reviewed; no changes.

10/01/2024: Code Reference section updated to add new ICD-10 diagnosis code G90.89.

11/07/2024: Policy reviewed; no changes.

12/31/2024: Code Reference section updated to make note of deleted CPT code 96003.

SOURCE(S)

1. Blue Cross Blue Shield Association policy #2.01.03

2. Blue Cross Blue Shield Association policy #2.01.35

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.

Covered Codes

 Investigational Codes

CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.