Failed conservative treatment (eg, medications, physical therapy, etc.Persistent or progressive symptoms and.Motor conduction studies of the median nerve recording from the thenar muscle and of one other nerve in the symptomatic limb to include measurement of distal latency Ĭervical, thoracic or lumbar radiculopathyįor evaluation of cervical, thoracic or lumbar radiculopathy when all of the following criteria are met: Median sensory conduction across the wrist over a short (7 to 8 cm) conduction distance.Comparison of median sensory conduction across the wrist with radial or ulnar sensory conduction across the wrist in the same limb or.If the initial median sensory nerve conduction study across the wrist has a conduction distance greater than 8 cm, and the results are normal, additional studies as listed below:.Sensory conduction studies across the wrist of the median nerve, and if the results are abnormal, of one other sensory nerve in the symptomatic limb and.The following disease-specific criteria are met, where applicable:įor evaluation of individuals suspected of having carpal tunnel syndrome:.It may also be waived when the purpose of the NCV study is solely to diagnose or rule out one of the following: carpal tunnel syndrome, Charcot-Marie-Tooth disease,myasthenia gravis or Lambert-Eaton myasthenic syndrome and The requirement for needle EMG with NCV may be waived for persons on anti-coagulant therapy with warfarin (Coumadin), direct thrombin inhibitors (e.g., dabigatran (Pradaxa), desirudin (Iprivask)), or heparins that can not be interrupted. The member has had a needle electromyographic (EMG) study to evaluate the condition either concurrently or within the past year.Peripheral neuropathy - unexplained peripheral neuropathy with pain of a neuropathic pattern, and with demonstrated motor loss or sensory loss, all of unknown etiology and.Localization of focal neuropathies or compressive lesions (e.g., Bell's palsy of the facial nerve, carpal tunnel syndrome, cubital tunnel syndrome, tarsal tunnel syndrome, nerve root compression, neuritis, motor neuropathy, mononeuropathy, radiculopathy, plexopathy) or. ![]() Differential diagnosis of symptom-based complaints (e.g., pain in limb or joint, weakness, fatigue, cramps, twitching (fasciculations), disturbance in skin sensation or paresthesias ) provided the clinical assessment supports the need for a study or.Differential diagnosis of physical examination findings of sensory loss, weakness and/or muscle atrophy with no known etiology (e.g., diabetes, hypothyroidism, lupus, rheumatoid arthritis, etc.) or.Diagnosis or confirmation of suspected generalized neuropathies (including uremic, metabolic or immune) (e.g., amyotrophic lateral sclerosis, Guillain-Barré Syndrome, muscular dystrophy, post-polio syndrome) or.Diagnosis of muscle disorders (e.g., myositis, myopathy) or.Diagnosis and monitoring of neuromuscular junction disorders (e.g., myasthenia gravis, myasthenic syndrome) using repetitive nerve stimulation or.Diagnosis and prognosis of traumatic nerve lesions (e.g., spinal cord injury, trauma to nerves) or.Member has any of the following indications: This Clinical Policy Bulletin addresses nerve conduction studies.Īetna considers nerve conduction velocity (NCV) studies medically necessary when the following criteria are met: Number: 0502 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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