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Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
07.03.09x

Policy

MEDICALLY NECESSARY 

INDEX OF MEDICALLY NECESSARY INDICATIONS
 
This policy addresses numerous medically necessary indications for electrodiagnostic studies. Please see below for the specific medical neces​sity criteria. (NOTE: Not Medically Necessary and Experimental/Investigational sections below must also be reviewed).

Electrodiagnostic (EDX) Studies​​​​
​Needle Electromyography (NEMG) and Nerve Conduction studies (NCS)
​NEMG Performed Without NCS
  • N​EMG of anal and urethral sphincter
  • NEMG for precise muscle location for intramuscular agents
  • NEMG of the larynx
​​NCS Performed Without NEMG
Other Electrodiagnostic Studies 
  • Single Fiber EMG (SFEMG)
  • ​Neuromuscular Junction Testing
  • Neurophysiology Evoked Potentials (NEPs)
    • ​Somatosensory Evoked Potentials (SEPs)
    • Brainstem Auditory Evoked Potentials (BAEPs)
    • Visual Evoked Potentials​ (VEPs)

NEEDLE ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES 
​
Needle electromyography (NEMG) and nerve conduction studies (NCS), which provide amplitude, latency, configuration, and conduction velocity data, are considered medically necessary ​when they are performed and interpreted at the same time, on site, and in real time for any of the following circumstances:​
  • ​Plexopathy (including idiopathic, traumatic, inflammatory, or infiltrative, radiation-induced, brachial plexopathies (e.g., neuralgic amyotrophy, thoracic outlet syndrome), and lumbosacral plexopathies (e.g., diabetic, nondiabetic lumbosacral radiculoplexus neuropathy)
  • Focal neuropathies (e.g., entrapment neuropathies or compressive lesions/syndromes such as carpal tunnel syndrome, ulnar neuropathy, tarsal tunnel syndrome, femoral neuropathy, saphenous neuropathy, lateral femoral cutaneous neuropathy, peroneal [fibular] neuropathy, tibial neuropathies, sciatic neuropathy)
  • Generalized neuropathies such as metabolic (e.g., diabetic, uremic), toxic, hereditary or immune-mediated
  • Motor neuron disease (e.g., amyotrophic lateral sclerosis [ALS] or Lou Gehrig's disease)
  • Myopathy, including inflammatory myopathies such as polymyositis and dermatomyositis, congenital myopathies, congenital and hereditary dystrophic and nondystrophic myopathies, including myotonic muscular dystrophy, acquired myopathies (drug-induced myopathy associated with statins, thyroid related), metabolic myopathies (e.g., McArdle disease) (including polymyositis and dermatomyositis; myotonic and congenital myopathies)
  • Myotonic disorders (e.g., drug-induced myotonia)
  • Neuromuscular junction disorders (e.g., myasthenia gravis, Lambert-Eaton myasthenic syndrome, botulism)
  • Polyneuropathies
  • Radiculopathy: cervical, thoracic, or lumbosacral
  • Spinal cord disorders (i.e., myelopathy)
  • Symptom-based presentations such as “pain in limb," weakness, cramping/twitching, disturbance of skin sensation or “paresthesia" when appropriate pre-test evaluations are inconclusive, and the clinical assessment unequivocally supports the need for the study
  • Traumatic nerve lesions, for diagnosis and prognosis
  • Mononeuropathy and polyneuropathy (metabolic, degenerative, hereditary)
​​​​NEMG PERFORMED WITHOUT NCS
​
NEMG when performed without NCS is considered medically necessary for all of the following situations, including but not limited to:
  • Conditions that affect the urethral or anal sphincter
    • Constipation
    • Diabetic autonomic (poly) neuropathy ​
    • Neurogenic conditions (e.g., multiple sclerosis, spinal cord injury, paralysis, or motor neuron disease)
    • Bladder outlet obstruction (a blockage at the base of the bladder that reduces or prevents the flow of urine into the urethra)
    • Urinary incontinence 
    • Fecal incontinence
  • Precise muscle location with NEMG for injection of intramuscular agents (e.g., botulinum toxin, phenol or other substances for nerve blocking or chemodenervation) for all of the following conditions:
    • Paralysis (e.g., monoplegia, hemiplegia, diplegia, quadriplegia, and paraplegia)
    • Hyperhydrosis
    • Bladder and anal disorders or incontinence​
    • Facial spasm
    • Chronic migraine
    • Nerve palsy: oculomotor, trochlear, abducent
    • Strabismus (e.g., esotropia, extropia, and cyclotropia)
  •  Conditions that affect the larynx

    • Paralysis of vocal cords and larynx
    • Dysphagia
    • Dysphonia
​​​​NCS PERFORMED WITHOUT NEMG

NCS when performed without NEMG are considered medically necessary for all of the following situations:
  • ​​​Individuals treated with anticoagulants such as warfarin (Coumadin), rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis), edoxaban (Lixiana), clopidogrel (Plavix), ticagrelor (Brilinta), ticlopidine (Ticlid), prasugrel (Effient), varapaxar (Zontivity), dipyridamole, cilostazol (Pletal)
  • Individuals with significant lymphedema in the affected extremity
  • Individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome​
​RELATED ELECTRODIAGNOSTIC STUDIES

Single-fiber electromyography (SFEMG) is considered medically necessary for all of the following conditions:

  • Ocular myasthenia
  • Myasthenia gravis
  • Myasthenic syndrome (e.g., Lambert-Eaton myasthenic syndrome)

Neuromuscular junction testing (NJT) is considered medically necessary for all of the following conditions:

  • Neuromuscular junction disorders (e.g., myasthenia gravis, Lambert-Eaton myasthenic syndrome, botulism)
  • Carnitine deficiency
  • Glycogen storage diseases (e.g., Pompe disease, Forbes-Cori disease, McArdle disease)
  • Myopathy (including myotosis)
  • Myalgia
  • Muscle weakness and atrophy
  • Dysphagia
​The following neurophysiology evoked potentials (NEPs) tests are considered medically necessary:​

Somatosensory evoked potentials (SEPs) and central motor evoked potentials (CMEPs) ​for all of the following conditions:

  • Spinal cord trauma
  • Degenerative, nontraumatic spinal cord lesions (e.g., cervical spondylosis with myelopathy)
  • Multiple sclerosis
  • Spinocerebellar degeneration
  • Myoclonus
  • Coma
  • Intraoperative monitoring
  • Subacute combined degeneration
  • Other diseases of myelin ​​​(e.g., adrenoleukodystrophy, adrenomyeloneuropathy, metachromatic leukodystrophy, and Pelizaeus-Merzbacher disease)
  • Syringomyelia
  • Hereditary spastic paraplegia​
​Brainstem auditory evoked potentials (BAEPs) for all of the following conditions:
  • Asymmetric hearing loss
  • Unilateral tinnitus
  • Sudden hearing loss
  • Cerebellopontine angle tumor
  • Demyelinating disorder
  • Functional hearing loss
  • Ototoxic drug therapy monitoring including chemotherapy or antibiotics
  • Auditory neuropathy
  • Acoustic neuroma
  • Preoperative baseline for:
    • Posterior fossa surgery
    • Cochlear implant
  • Postoperative testing for:
    • Cochlear implant​
Visual evoked potentials​ (VEPs) for all of the following conditions:
  • Confirm diagnosis of multiple sclerosis when clinical criteria are inconclusive
  • Detect optic neuritis at an early, subclinical stage
  • Diseases of the optic nerve:
    • Ischemic optic neuropathy
    • Pseudotumor cerebri
    • Toxic amblyopias
    • Nutritional amblyopias
    • Neoplasms compressing the anterior visual pathways
    • Optic nerve injury or atrophy
    • Hysterical blindness (to rule out)
  • Monitor the visual system during optic nerve (or related) surgery (monitoring of short-latency evoked potential studies).​
Please refer to Attachment A of this policy for American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines for recommended maximum number of EMG.

NOT MEDICALLY NECESSARY

All of the following situations are considered not medically necessary and therefore not covered​ for needle EMG or NCS:
  • ​Delayed and incomplete interpretation of the NEMG study; NEMG study must be performed and interpreted with the NCS on site and in real time (excluding conditions listed above)
  • Psychophysical measurements (electrical, vibratory or thermal perceptions), even though they may involve delivery of a stimulus​
  • Testing for polyneuropathy of diabetes in individuals without clinical deficits or for the sole purpose of monitoring disease intensity or treatment efficacy
  • NCS accomplished with discriminatory devices that use fixed anatomic templates and computer-generated reports used as an adjunct to physical examination routinely on all individuals
  • Physiologic recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor using wearable devices with accelerometers or gyroscopes
  • NCS or EMG for muscle pain without the presence of other abnormalities on examination or in laboratory testing
  • Surface electromyography (SEMG)
  • Macroelectromyography (macro-EMG)​
  • Needle electrooculomyography
  • NEMG of the hemidiaphragm
  • Blink reflex test​
  • NEMG for the following situations:
    • ​Definitive diagnosis based on paraspinal NEMG in areas with scar from past surgeries (e.g., previous laminectomies)
    • Isolated neck or back pain after a motor vehicle accident
    • Exclusive testing of intrinsic foot muscles in the diagnosis of proximal lesions
    • Premature needle EMG testing after trauma when EMG changes have not taken place
    • Multiple uses of needle EMG in the same individual at the same location of the same limb for the purpose of optimizing botulinum toxin injections
​EXPERIMENTAL/INVESTIGATIONAL

The following services are considered experimental/investigational and, therefore, not covered because the safety and/or effectiveness of this service cannot be established by review of the available published peer-reviewed literature:​ ​

  • Motor and/or sensory nerve conduction using preconfigured electrode arrays, with or without F-wave study
  • Quantitative Sensory Testing (QST) (e.g., hot-cold, touch, vibration) 
  • Sensory Nerve Conduction Threshold (sNCT) Testing including Pain Perception Threshold (PPT), Pain Tolerance Threshold (PTT), and Voltage-Actuated Sensory Nerve Conduction Threshold (VsNCT)​​
PROFESSIONAL AND TECHNICAL COMPONENT REIMBURSEMENT

  • Only physicians (MD/DO) are eligible to receive reimbursement for the professional component of EMG. Physicians may also receive reimbursement for the technical component if they performed that service.
  • Nonphysician professional providers (e.g., physical therapists) are only eligible to receive reimbursement for the technical component of EMG.
STATE OF NEW JERSEY

In the state of New Jersey, as defined by the scope of practice regulations, only a physician may perform needle EMG studies.

REQUIRED DOCUMENTATION

Documentation of the performing professional provider's qualifications must be made available to the Company upon request.

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the health care professional's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

Guidelines

MINIMUM STANDARDS FOR NEEDLE ELECTROMYOGRAPHY (EMG)

The Company has adopted the minimum standards for needle EMG as defined by the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Minimum standards include the following:
  • Testing should be performed using equipment that assesses all parameters of the recorded signals.
    • Studies that are performed with devices designed only for screening, rather than diagnosing, are not eligible under this policy.
  • The number of tests performed should be the minimum that are necessary to establish an accurate diagnosis, which may include evaluation of one or more nerves that have normal test results for comparative purposes.
Please refer to Attachment A of this policy for the AANEM recommendations regarding the maximum number of studies that should be performed for each condition, as well as examples of clinical situations when additional testing may be appropriate. These recommendations should not apply if the individual requires evaluation by more than one consultant (i.e., a second opinion or an expert opinion at a tertiary care center) in a given year or if the individual requires evaluation for a second diagnosis in a given year.

CLINICAL SPECIALIZATION PROGRAMS

Eligible professional providers performing a needle EMG should have sufficient knowledge and experience in needle EMG. Competency to perform needle EMG can be demonstrated through training from a clinical specialization program. Candidates are able to demonstrate their level of competence from a certification organization such as, but not limited to, the following:
  • American Board of Electrodiagnostic Medicine (ABEM)
  • American Board of Psychiatry and Neurology Added Qualifications in Clinical Neurophysiology (ABPN-CN)
  • American Board of Clinical Neurophysiology, Inc. (ABCN)
  • American Board of Neurophysiological Monitoring (ABNM)
  • American Board of Registration of Electrodiagnostic Technologists (ABRET)
  • American Society of Electroneurodiagnostic Technologists, Inc. (ASET)
SURFACE ELECTROMYELOGRAM

Electromyographic studies performed with surface electrodes (i.e., SEMG) instead of needle technology (i.e., needle EMG) are not to be billed with the standard electrodiagnostic code (i.e., 95860).

In addition, SEMG studies described in this policy are reported using Healthcare Common Procedure Coding System (HCPCS) code S3900. It should not be confused with the type of EMG described in Current Procedural Terminology (CPT) code 51784, in which the physician places a pad in the anal or urethral sphincter and measures the electrical activity when the bladder is filled and during emptying.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, needle EMG is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in the medical policy are met. However, services that are identified in this policy as not medically necessary are not eligible for coverage or reimbursement by the Company.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

The FDA has approved several devices that are used to perform needle EMG.

Description

NEEDLE ELECTROMYOGRAPHY (EMG)

EMG is the study and recording of the intrinsic electrical properties of skeletal muscles. EMG is performed to diagnose, define, and follow diseases of the peripheral nervous system and muscle. Needle EMG is performed by inserting an electrode through the skin into appropriate muscles, one at a time. The needle translates the amount and intensity of the electrical activity into waveforms that are displayed on a computer screen. Generally, the electrodes are of two types: monopolar or concentric. In addition, needle EMG can be performed as a part of intraoperative neurophysiological monitoring (INM), which monitors the integrity of neural pathways during surgeries where there is a potential for damage to neural integrity.

After the needle EMG is performed on the muscle, the data (the waveforms, sounds, and feel of the muscle) are analyzed to determine if additional muscles need to be studied. The muscles studied will vary depending on the differential diagnosis and the ongoing synthesis of new information that is obtained while the test is being performed. The electromyographer relies on ongoing real-time clinical diagnostic evaluation when deciding whether to continue, modify, or conclude a needle EMG. This requires a comprehensive knowledge base of anatomy, physiology, and neuromuscular diseases, as well as an awareness of the influence of age, temperature, and body height on the results.

Needle EMG results reflect the integrity of the functioning connection between a nerve and its innervated muscle, as well as the integrity of the muscle itself. The axon innervating a muscle is primarily responsible for the muscle's volitional contraction, survival, and trophic functions. Thus, interruption of the axon will alter the EMG.

Neurogenic disorders can be distinguished from myopathic disorders by a carefully performed needle EMG. For example, both polymyositis and amyotrophic lateral sclerosis (ALS) produce manifest weakness; however, polymyositis carries a very different prognosis and treatment than ALS. A needle EMG is essential in making a distinction between the two disorders because the needle electrode allows the muscle's electrical characteristics at rest and during activity to be interpreted by the electromyographer. This interpretation includes an analysis of oscilloscope tracings and the characteristic sounds that are produced by electrical potentials. The final interpretation of the study is a combination of the individual's history, a physical examination, and the muscles tested. Similarly, classification of nerve trauma into axonal versus demyelinating categories, with corresponding differences in prognoses, is possible with a needle EMG.

NERVE CONDUCTION STUDIES (NCS) CONDUCTED WITH NEEDLE EMG

NCS is performed together with a needle EMG. NCS measures the electrical activity of muscles or the integrity of the functioning connection between a nerve and its innervated muscle, as well as the integrity of the muscle itself. The American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) recommends that except under unique situations (e.g., presence of lymphedema, current use of anticoagulants), NCS and needle EMG should be performed together in a study for an accurate clinical diagnosis of peripheral nervous system disorders. The reporting of NCS and needle EMG study results should be integrated into a unifying diagnostic impression.​


NCSs may be conducted without NEMG in some situations (e.g., individuals with significant lymphedema, with entrapment neuropathies, or on anticoagulants), but this should be the exception rather than the normal practice pattern.


SINGLE-FIBER EMG

In single-fiber needle EMG, a specially designed needle electrode is used to record and identify action potentials (APs) from individual muscle fibers. These recordings are used to calculate the neuromuscular jitter and the muscle fiber density (FD). Jitter is defined as the variability in time between activation of the motor nerve and generation of the muscle fiber AP; it reflects the normality of nerve-to-muscle transmission. Normal jitter varies among muscles and muscle fibers within individual muscles. To determine if jitter is abnormally increased, statistical analysis is performed from the recordings of a population of muscle fibers within each treated muscle. When neuromuscular transmission is sufficiently abnormal and nerve activation produces no muscle AP, blocking is seen. Increased jitter, blocking, or both may occur in a variety of primary disorders of neuromuscular transmission (e.g., myasthenia gravis). Jitter and FD may be measured in one or more muscles depending on the condition being evaluated and the results of the testing.


NEUROMUSCULAR JUNCTION TESTING

Neuromuscular junction testing, also known as repetitive nerve stimulation, is an electrodiagnostic test that is used to diagnose NMJ disorders such as myasthenia gravis, Lambert-Eaton myasthenic syndrome, and botulism. The test involves recording muscle responses to a series of nerve stimuli and may be used in association with NCSs of the same nerves.


​NEUROPHYSIOLOGY EVOKED POTENTIALS (NEPs)

Somatosensory Evoked Potentials (SEPs)

While motor and sensory NCS generally detect function in large-caliber peripheral nerve fibers, SEP tests conduction in central sensory pathways. SEP is an extension of the electrodiagnostic evaluation. SEP is a noninvasive study performed by repetitive submaximal stimulation of a sensory or mixed sensorimotor peripheral nerve. Amplitude, peak, and interpeak latency measurements with side-to-side comparisons are used to assess conduction abnormalities. SEP has proven useful in evaluating various conditions including but not limited to: spinal cord trauma, subacute combined degeneration, nontraumatic spinal cord lesions, and multiple sclerosis.​​


Brainstem Auditory Evoked Potentials (BAEPs)

BAEPs evaluate the auditory nerve pathways from the ears through the brain stem. A clicking sound is presented to one ear at a time. The electrical activity of this signal is recorded by electrodes on the scalp. The averaged response is displayed as a waveform that contains peaks and troughs, which correspond to various points along the hearing pathway. The time between these peaks is measured and compared to normal data. A delay in a component of the response might indicate an abnormality at specific anatomic sites in the acoustic nerve or brainstem.


Visual Evoked Potentials​ (VEPs)​

​VEPs evaluate the visual nervous system pathways from the eyes to the occipital cortex of the brain. VEP or VER involves stimulation of the retina and optic nerve with a shifting checkerboard pattern or flash method. This external visual stimulus causes measurable electrical activity in neurons within the visual pathways. This is called the Visual Evoked Response (VER) and is recorded by electroencephalography electrodes located over the occiput. Using special computer techniques, the evoked responses measured over multiple trials are amplified and averaged. A characteristic waveform is produced. With pattern-shift VER, the waveform normally appears as a straight line with a single positive peak (100 msec after stimulus presentation). Abnormalities in this characteristic waveform may be seen in a variety of pathologic processes involving the optic nerve and its radiations. Pattern-shift VER is a highly sensitive means of documenting lesions in the visual system. It is especially useful when the disease process is subclinical, e.g., ophthalmologic exam is normal and individual lacks visual symptoms.​


H-REFLEX AND F-WAVE STUDY

Late response (H-reflex and F-wave study) testing is a type of NCS usually performed on nerves more proximal to the spine. The H-reflex involves conduction from the periphery to and from the spinal cord. The H-reflex study involves the assessment of the ​gastrocnemius/soleus muscle complex in the calf and is usually performed bilaterally due to the need to assess symmetrical results in determining abnormalities. The F-wave study is a late response similar to the H-reflex. F-wave studies are used to assess the proximal segments of the motor nerve function and are performed in combination with the examination of motor nerves. Both studies are helpful in diagnosing conditions of radiculopathies, plexopathies, polyneuropathies (particularly with multifocal conduction block, Guillain-Barré syndrome or chronic inflammatory demyelinating polyneuropathy), and proximal mononeuropathies. Late response studies are complementary to NCS and are performed during the same evaluation.


SURFACE EMG (SEMG)

A surface EMG (SEMG) is not the same as a conventional EMG. SEMG involves a noninvasive, computer-based technique that records the electrical impulses of the nerves and muscles through electrodes that are placed on or passed over the surface of the skin. SEMG differs from needle EMG with respect to technical requirements and electrical properties. SEMG electrodes measure from a wide area of muscle, have a relatively narrow frequency band, have low signal resolution, and are highly susceptible to movement artifact. According to the AANEM, there are no clinical indications for the use of SEMG in the diagnosis and treatment of disorders of the nerves or muscles.​


QUANTITATIVE SENSORY TESTING (QST)

QST is the noninvasive assessment and quantification of sensory nerve function, for which there are US Food and Drug Administration (FDA)-approved devices. QST involves psychophysical tests that are performed to provide a quantitative value to the subjective feeling of sensation. A transcutaneous electrical stimulus is used to determine the minimum stimulus that evokes sensation in the individual. Individuals are asked to identify the absence or presence of stimulus by undergoing a forced-choice protocol, with the threshold of perception as the measured response. Proponents of this test claim that neuropathies can be diagnosed by using transcutaneous electrical stimulus. Stimuli used in QST include touch, pressure, pain, temperature, and vibration.


SENSORY NERVE CONDUCTION THRESHOLD (sNCT)​ TESTING

The sNCT is a psychophysical assessment of both central and peripheral nerve functions. It measures the detection threshold of accurately calibrated sensory stimuli. This procedure is intended to evaluate and quantify function in both large and small caliber fibers for the purpose of detecting neurologic disease. Sensory perception and threshold detection are dependent on the integrity of both the peripheral sensory apparatus and peripheral-central sensory pathways. In theory, an abnormality detected by this procedure may signal dysfunction anywhere in the sensory pathway from the receptors, the sensory tracts, the primary sensory cortex, to the association cortex.


This procedure is different and distinct from assessment of nerve conduction velocity, amplitude and latency. It is also different from short-latency somatosensory evoked potentials.​


References

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Neblett R, Brede E, Mayer TG, et al. What is the best surface EMG measure of lumbar flexion-relaxation for distinguishing chronic low back pain patients from pain-free controls? Clin J Pain. 2013;29(4):334-340.

Novitas Solutions, Inc. Local Coverage Article (LCA). A54095: Billing and Coding: Nerve Conduction Studies and Electromyography. (Original: 10/01/2015). Revised: 10/01/2025. Available at: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=54095&ver=68&=​​. Accessed January 21, 2026.​

Novitas Solutions, Inc. Local Coverage Article (LCA). A56773: Billing and Coding: Neurophysiology Evoked Potentials (NEPs). (Original: 08/08/2019). Revised: 10/01/2025. Available at: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56773. Accessed January 21, 2026.

Novitas Solutions, Inc. Local Coverage Determination (LCD). L34975:Neurophysiology Evoked Potentials (NEPs). (Original: 10/01/2015). Revised: 12/17/2019. Available at: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=34975&ver=67. Accessed January 21, 2026.

Novitas Solutions, Inc. Local Coverage Determination (LCD). L35081: Nerve Conduction Studies and Electromyography. (Original: 10/01/2015). Revised: 12/10/2023. Available at: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35081​. Accessed January 21, 2026.

Olney RK, Lewis RA, Putnam TD, et al. Consensus criteria for the diagnosis of multifocal motor neuropathy. Muscle Nerve. 2003;27(1):117-121.

Peach JP, McGill SM. Classification of low back pain with the use of spectral electromyogram parameters. Spine. 1998;23(10):1117-1123.

Pullman SL, Goodin DS, Marquinez AI, et al. Clinical utility of surface EMG: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2000;55(2):171-177.

Rabie M, Jossiphov J, Nevo Y. Electromyography (EMG) accuracy compared to muscle biopsy in childhood. J Child Neurol. 2007;22(7):803-808.

Roy SH, Oddsson LI. Classification of paraspinal muscle impairments by surface electromyography. Phys Ther. 1998;78(8):838-851.

Schabrun SM, Elgueta-Cancino EL, Hodges PW. Smudging of the Motor Cortex Is Related to the Severity of Low Back Pain. Spine (Phila Pa 1976). 2017;42(15):1172-1178. 

Sheeran L, Sparkes V, Caterson B, et al. Spinal position sense and trunk muscle activity during sitting and standing in nonspecific chronic low back pain: classification analysis. Spine (Phila Pa 1976). 2012;37(8):E486-495.

Tulipan JE, Lutsky KF, Maltenfort MG, et al. Patient-Reported Disability Measures Do Not Correlate with Electrodiagnostic Severity in Carpal Tunnel Syndrome. Plast Reconstr Surg Glob Open. 2017;5(8): e1440.

U.S. Food and Drug Administration (FDA). Needle Electrodes. 510(k) summary. [FDA Web site]. 10/07/10. Available at: Center for Devices and Radiological Health. Available at: http://www.fda.gov. Accessed January 21, 2026​​.

Van Damme B, Stevens V, Perneel C, et al. A surface electromyography based objective method to identify patients with nonspecific chronic low back pain, presenting a flexion related movement control impairment. J Electromyogr Kinesiol. 2014;24(6):954-964.​​

Coding

CPT Procedure Code Number(s)
MEDICALLY NECESSARY

THE FOLLOWING CODES ARE USED TO REPRESENT NEEDLE ELECTROMYOGRAPHY (NEMG) AND NERVE CONDUCTION STUDIES (NCS) - Correlating Diagnosis Codes in Attachment B

95860, 95861, 95863, 95864, 95867, 95868, 95869, 95870, 95885, 95886, 95887, 95907, 95908, 95909, 95910, 95911, 95912, 95913

THE FOLLOWING CODES ARE USED TO REPRESENT ELECTROMYOGRAPHY (EMG) OF ANAL OR URETHRAL SPHINCTER - Correlating Diagnosis Codes in Attachment C

51784, 51785

THE FOLLOWING CODE IS USED TO REPRESENT NEEDLE ELECTORMYOGRAPHY (NEMG) FOR GUIDANCE IN CONJUNCTION WITH CHEMODENERVATION - Correlating Diagnosis Codes in Attachment D​

​95874

THE FOLLOWING CODE IS USED TO REPRESENT NEUROMUSCULAR JUNCTION TESTING (NJT)  - Correlating Diagnosis Codes in Attachment E
​​
95937 ​
​
​THE FOLLOWING CODES ARE USED TO REPRESENT SOMATOSENSORY EVOKED POTENTIALS (SEP) AND CENTRAL MOTOR EVOKED POTENTIALS (CMEP) - Correlating Diagnosis Codes in Attachment F​​
​
95925, 95926, 95927, 95928, 95929, 95938, 95939

THE FOLLOWING CODES ARE USED TO REPRESENT BRAINSTEM AUDITORY EVOKED POTENTIALS (BAEP) - Correlating Diagnosis Codes in Attachment G
​​
92651, 92652, 92653​

THE FOLLOWING CODE IS USED TO REPRESENT VISUAL EVOKED POTENTIAL (VEP) - Correlating Diagnosis Codes in Attachment H​
​
95930

THE FOLLOWING CODE IS USED TO REPRESENT NEEDLE ELECTROMYOGRAPHY (NEMG) OF THE LARYNX - Correlating Diagnosis Codes in Policy Coding Table
​
95865

THE FOLLOWING CODE IS USED TO REPRESENT SINGLE FIBER ELECTROMYOGRAPHY (SFEMG) - Correlating Diagnosis Codes in Policy Coding Table​
​
95872

NOT MEDICALLY NECESSARY

92265, 95866, 95933  

THE FOLLOWING UNLISTED CODE IS USED TO REPRESENT MACROELECTROMYOGRAPHY (MACRO-EMG)​​

95999 
​
EXPERIMENTAL/INVESTIGATIONAL
​
0106T, 0107T, 0108T, 0109T, 0110T, 95905​

ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)
MEDICALLY NECESSARY

NEEDLE ELECTROMYOGRAPHY (NEMG) OF THE LARYNX IS CONSIDERED MEDICALLY NECESSARY FOR THE FOLLOWING INDICATIONS (CPT 95865​):
​
J38.01 Paralysis of vocal cords and larynx, unilateral
J38.02 Paralysis of vocal cords and larynx, bilateral
R06.02 Shortness of breath
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia
R49.0 Dysphonia
R49.8 Other voice and resonance disorders

SINGLE FIBER ELECTROMYOGRAPHY (SFEMG) IS CONSIDERED MEDICALLY NECESSARY FOR THE FOLLOWING INDICATIONS (CPT 95872​):​​
​
G70.00 Myasthenia gravis without (acute) exacerbation
G70.01 Myasthenia gravis with (acute) exacerbation
G70.1 Toxic myoneural disorders
G70.2 Congenital and developmental myasthenia
G70.80 Lambert-Eaton syndrome, unspecified
G70.81 Lambert-Eaton syndrome in disease classified elsewhere
G70.89 Other specified myoneural disorders
G70.9 Myoneural disorder, unspecified
G73.1 Lambert-Eaton syndrome in neoplastic disease
G73.3 Myasthenic syndromes in other diseases classified elsewhere
H02.421 Myogenic ptosis of right eyelid
H02.422 Myogenic ptosis of left eyelid
H02.423 Myogenic ptosis of bilateral eyelids
H05.821 Myopathy of extraocular muscles, right orbit
H05.822 Myopathy of extraocular muscles, left orbit
H05.823 Myopathy of extraocular muscles, bilateral
H53.2 Diplopia
H53.8 Other visual disturbances

See the Following Attachments for the Medically Necessary Indications​:
​Attachment​​​
​Procedures 
​B
​Needle Electromyography (NEMG) and Nerve Conduction Studies (NCS)
​C
​Electromyography (EMG) of Anal or Urethral Sphincter 
​D
​Needle Electromyography (NEMG) for Guidance in Conjunction with Chemodenervation
​E
​Neuromuscular Junction Testing (NJT)
​F
​Somatosensory Evoked Potentials (SEP) and Central Motor Evoked Potentials (CMEP)
​G
​Brainstem Auditory Evoked Potentials (BAEP)
​H
​Visual Evoked Potentials​ (VEP)


HCPCS Level II Code Number(s)
NOT MEDICALLY NECESSARY

S3900 Surface electromyography (EMG)​

EXPERIMENTAL/INVESTIGATIONAL

​G0255 Current perception threshold/sensory nerve conduction threshold (sNCT) test, per limb, any nerve

Revenue Code Number(s)
N/A



Coding and Billing Requirements


Policy History

Revisions From ​07.03.09x:

​04/01/2026
​This policy has been reissued in accordance with the Company's annual review process.​

​10/01/2025

​Inclusion of a policy in a Code Update memo does not imply that a full review of the policy was completed at this time.

T
his policy has been identified for the ICD-10 CM code update, effective 10/01/2025.​
​
The following ICD-10 CM code been deleted from this policy:
  • G35 Multiple sclerosis
The following ICD-10 CM codes been added to this policy:
 
  • G35.A Relapsing-remitting multiple sclerosis
  • G35.B0 Primary progressive multiple sclerosis, unspecified
  • G35.B1 Active primary progressive multiple sclerosis
  • G35.B2 Non-active primary progressive multiple sclerosis
  • G35.C0 Secondary progressive multiple sclerosis, unspecified
  • G35.C1 Active secondary progressive multiple sclerosis
  • G35.C2 Non-active secondary progressive multiple sclerosis
  • G35.D Multiple sclerosis, unspecified
The following ICD-10 CM narratives have been revised in this policy:
  • ​S74.21XA 
    • FROM: Injury of cutaneous sensory nerve at hip and high level, right leg, initial encounter
    • TO: ​Injury of cutaneous sensory nerve at hip and thigh level, right leg, initial encounter
  • ​S74.21XD
    • FROM: Injury of cutaneous sensory nerve at hip and high level, right leg, subsequent encounter
    • TO: Injury of cutaneous sensory nerve at hip and thigh level, right leg, subsequent encounter
  • S74.21XS
    • FROM: Injury of cutaneous sensory nerve at hip and high level, right leg, sequela​
    • TO: Injury of cutaneous sensory nerve at hip and thigh level, right leg, sequela

Revisions From ​07.03.09w:
09/22/2025​
This version of the policy will become effective 09/22/2025.


The following changes have been made to the language of the policy:

  • The following condition is no longer considered Not Medically Necessary: “Pattern-setting limited limb muscle examinations, without paraspinal muscle testing for the diagnosis of radiculopathies"
  • The following condition is no longer considered Not Medically Necessary and currently Not Covered: Non-invasive EDX studies using portable hand-held devices or automated point of care nerve conduction monitoring systems, which are incapable of real-time waveform display and analysis
  • Added the following condition as Not Medically Necessary​: Psychophysical measurements (electrical, vibratory or thermal perceptions), even though they may involve delivery of a stimulus
  • Added EDX studies, VEP and BAEP as medically necessary
Applicable codes have been added to the policy to align with policy language.

Revisions From​ 07.03.09v:
 09/30/2024
​This version of the policy will become effective 09/30/2024.

This policy supersedes 07.03.09u Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG). The following policies have been added to this currently effective policy:

  • ​Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
  • Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter​
Notable coding changes include the alignment of the appropriate diagnoses to the medically necessary CPT code listed within the appropriate attachment.

The following CPT code's coverage determination has changed from experimental//investigational to not medically necessary:
  • S3900​
The following CPT codes' coverage determination have changed from medically necessary to not medically necessary
  • 92265 Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report
  • 95866 Needle electromyography; hemidiaphragm
The following CPT codes' coverage determination have been added as not medically necessary
  • 95999 ​(represents macro-EMG)
  • 95933 Orbicularis oculi (blink) reflex, by electrodiagnostic testing​
The following rev code was removed from this policy
  • ​0922​

Revisions From​ 07.03.09u:
​10/18/2023

​The policy has been reviewed and reissued to communicate the Company's continuing position on ​​Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)​​.
​10/1/2023
​This policy has been identified for the ICD-10 Diagnosis code update, effective 10/01/2023.

The following ICD-10 Diagnosis codes have been added to Attachment B of this policy:
​G20.A1 Parkinson's disease without dyskinesia, without mention of fluctuations​
G20.A2 Parkinson's disease without dyskinesia, with fluctuations​
G20.B1 Parkinson's disease with dyskinesia, without mention of fluctuations
G20.B2 Parkinson's disease with dyskinesia, with fluctuations
G20.C​ Parkinsonism, unspecified
G37.81 Myelin oligodendrocyte ​glycoprotein antibody disease
G37.89 Other specified demyelinating diseases of central nervous system

​The following ICD-10 Diagnosis codes has been termed from Attachmen​t B of this policy:​
G20 Parkinson's Disease
G37.8 Other specified demyelinating disease of central nervous system​

Revisions From​ 07.03.09t:
​11/16/2022
​The policy has been reviewed and reissued to communicate the Company’s continuing position on ​​Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)​.​​
​10/01/2022
​​This policy has been identified for the ICD-10 Diagnosis code update, effective 10/01/2022.

The following ICD-10 Diagnosis codes have been added to Attachment C of this policy: G71.031, G71.032, G71.033, G71.0340, G71.0341, G71.0342, G71.0349, G71.035, G71.038, G71.039, G93.31, G93.32, G93.39​ 

The following ICD-10 Diagnosis code has been removed from Attachmen​t C of this policy:​ G93.3

​The following ICD-10 Diagnosis codes have been added to Attachment E of this policy: M62.5A0, M62.5A1, M62.5A2, M62.5A9

Revisions From 07.03.09s:
​03/21/2022
​This version of the policy will become effective 03/21/2022.

Policy language was added to indicate that for the sole purpose of diagnosing or confirming radiculopathy, needle electromyography (EMG) when not conducted and interpreted at the same time as a nerve conduction study (NCS) will be considered Not Medically Necessary and, therefore, not covered.​​​​

Revisions From 07.03.09r:
​10/01/2021
​This policy has been identified for the ICD-10 Diagnosis code update, effective 10/01/2021.

The following ICD-10 Diagnosis code has been removed from Attachmen​t E of this policy:​ M54.5

The following ICD-10 Diagnosis codes have been added to Attachment E of this policy: M54.50, M54.51, M54.59

Revisions From 07.03.09q:
12/16/2020
This policy has been reissued in accordance with the Company's annual review process.
​10/01/2020
​
This policy has been identified for the ICD-10 Diagnosis code update, effective 10/01/2020.

The following ICD-10 Diagnosis code has been removed from Attachmen​t B of this policy:​ G11.1

The following ICD-10 Diagnosis codes have been added to Attachment B of this policy as Medically Necessary: G11.10, G11.11, G11.19

The following ICD-10 Diagnosis code has been removed from Attachmen​t C of this policy:​ G71.2

The following ICD-10 Diagnosis codes have been added to Attachment C of this policy as Medically Necessary: G71.20, G71.21, G71.220, G71.228, G71.29

Revisions From 07.03.09p:
11/20/2019This policy has been reissued in accordance with the Company's annual review process.
10/01/2019This version of the policy will become effective 10/01/2019. The following ICD-10 codes have been added to the policy: M50.120 .

Revisions From 07.03.09o:
10/01/2018This version of the policy will become effective 10/01/2018. The following ICD-10 codes have been added to the policy:G51.31, G51.32, G51.33, G51.39, G71.00, G71.01, G71.02, G71.09, H02.151, H02.152, H02. 153, H02.154, H02.155, H02.156, H02.159, M79.10, M79.11, M79.12, M79.18. The following ICD-10 codes have been termed from the policy: G51.3, G71.0, M79.1.

Revisions From ​07.03.09n:
07/23/2018This version of the policy will become effective 07/23/2018. The following ICD-10 codes have been added to the policy: M50.020, M50.021, M50.022, M50.023, M50.120, M50.121, M50.122, M50.123, M50.220, M50.221, M50.222, M50.223, M50.320, M50.321, M50.322, M50.323, M50.820, M50.821, M50.822, M50.823, M50.920, M50.921, M50.922, M50.923. The following ICD-10 codes have been termed from the policy: I60.0, I60.21, I60.22, M50.02, M50.12, M50.22, M50.32, M50.82, M50.92.

Effective 10/05/2017 this policy has been updated to the new policy template format.
10/1/2025
10/2/2025
4/1/2026
07.03.09
Medical Policy Bulletin
Commercial
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No