Medical policy: Electromyography and Nerve Conduction Studies
Policy number: MP 2.063
Clinical benefit
- Minimize safety risk or concern.
- Minimize harmful or ineffective interventions.
- Assure appropriate level of care.
- Assure appropriate duration of service for interventions.
- Assure that recommended medical prerequisites have been met.
- Assure appropriate site of treatment or service.
Effective date: 9/1/2026
Policy
Electrodiagnostic assessment, consisting of electromyography (EMG), nerve conduction study (NCS), and related measures, may be considered medically necessary as an adjunct to history, physical exam (PE), and imaging studies when the following criteria are met:
- Signs and symptoms of peripheral neuropathy and/or myopathy are present; and
- Definitive diagnosis cannot be made by PE and imaging studies alone; and
- Work-up for one or more of the following categories of disease is indicated (see Policy Guidelines section):
- Compressive neuropathies
- Nerve root compression
- Traumatic nerve injuries
- Generalized and focal neuropathies/myopathies
- Plexopathies
- Motor neuron diseases
- Neuromuscular junction disorders.
A repeat electrodiagnostic assessment may be considered medically necessary when at least one of the following criteria have been met:
- Development of new symptoms or signs suggesting a second diagnosis in an individual who has received an initial diagnosis; or
- Interim progression of disease following an initial test that was inconclusive, such that a repeat test is likely to elicit additional findings; or
- Unexpected change(s) in the course of disease or response to treatment, suggesting that the initial diagnosis may be incorrect, and that reexamination is indicated.
Electrodiagnostic assessment, consisting of EMG, NCS, and related measures, is investigational when the above criteria are not met, including but not limited to, the following situations:
- Screening of asymptomatic individuals
- Serial assessments to evaluate progression of disease in an individual with a previously diagnosed neuropathy or myopathy
- Evaluation of treatment response in an individual with previously diagnosed neuropathy or myopathy
- Evaluation of severity of disease in an individual with previously diagnosed neuropathy or myopathy
There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with testing for these indications.
Automatic nerve conduction tests are considered investigational as there is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.
Policy guidelines
The following list gives specific diagnoses, according to categories of testing listed in the policy statement, for which EMG/NCS generally provides useful information in confirming or excluding the diagnosis, above that provided by clinical examination and imaging alone. The list includes the most common diagnoses for testing, but is not exhaustive. There may also be other less common disorders for which EMG/NCS provides useful diagnostic information.
- Compressive neuropathies
- Carpal tunnel syndrome
- Ulnar nerve entrapment
- Thoracic outlet syndrome
- Tarsal tunnel syndrome
- Other peripheral nerve entrapments
- Nerve root compression (when PE and magnetic resonance imaging [MRI] are inconclusive)
- Cervical nerve root compression
- Thoracic nerve root compression
- Lumbosacral nerve root compression
- Traumatic nerve injuries
- Generalized and focal polyneuropathies
- Diabetic neuropathy
- Uremic neuropathy
- Alcohol-related neuropathy
- Hereditary neuropathies
- Charcot-Marie-Tooth
- Other hereditary neuropathies
- Demyelinating polyneuropathies
- Guillain-Barré syndrome (acute)
- Chronic idiopathic demyelinating polyneuropathy
- Generalized myopathies
- Polymyositis
- Dermatomyositis
- Muscular dystrophies
- Plexopathies
- Cervical plexopathy
- Brachial plexopathy
- Lumbosacral plexopathy
- Motor neuron diseases
- Amyotrophic lateral sclerosis
- Progressive muscular atrophy
- Progressive bulbar palsy
- Pseudobulbar palsy
- Primary lateral sclerosis
- Neuromuscular junction disorders
- Myasthenia gravis
- Myasthenic syndrome
- Lambert-Eaton syndrome
The following recommendations on the number of repeat services are reproduced from the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) position statement (2023). These estimates do not represent absolute maximums for all individuals; they are defined by AANEM as being sufficient to make a diagnosis in at least 90% of individuals with that particular diagnosis. Therefore, there may be a small percentage of cases that require a greater number of tests than specified in table PG1.
Table PG1. Recommended Maximum Number of Electrodiagnostic Studies for Specific Diagnoses
Indication |
Needle EMG |
NCSs |
Other studies |
No. of tests |
No. of tests |
RNS testing |
|
|
Carpal tunnel (unilateral) |
1 |
7 |
0 |
|
Carpal tunnel (bilateral) |
2 |
10 |
0 |
|
Radiculopathy |
2 |
7 |
0 |
|
Mononeuropathy |
1 |
8 |
0 |
|
Polyneuropathy or mononeuropathy multiplex |
3 |
10 |
0 |
|
Myopathy |
2 |
4 |
2 |
|
Motor neuropathy (e.g., amyotrophic lateral sclerosis) |
4 |
6 |
2 |
|
Plexopathy |
2 |
12 |
0 |
|
Neuromuscular junction |
2 |
2 |
3 |
|
Tarsal tunnel syndrome (unilateral) |
1 |
8 |
0 |
|
Tarsal tunnel syndrome (bilateral) |
2 |
11 |
0 |
|
Weakness, fatigue, cramps, or twitching (focal) |
2 |
7 |
2 |
|
Weakness, fatigue, cramps, or twitching (general) |
4 |
8 |
2 |
|
Pain, numbness, or tingling (unilateral) |
1 |
9 |
0 |
|
Pain, numbness, or tingling (bilateral) |
2 |
12 |
0 |
Adapted from American Association of Electrodiagnostic Medicine (2023).
EMG: electromyography; NCS: nerve conduction study; RNS: repetitive nerve stimulation.
The American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) position statement (2023) also included minimum standards for a lab performing electrodiagnostic evaluation:
- Tests should be medically indicated.
- The tests should be performed using equipment that provides assessment of all parameters of the recorded signals. Equipment designed for screening purposes is not acceptable.
- The number of tests performed should be the minimum needed to establish an accurate diagnosis.
- The NCS should be performed by a physician or by a trained technician under the direct supervision of a physician.
- A trained physician must perform the needle EMG exam.
- One physician should perform and supervise all components of the electrodiagnostic testing and all testing should occur on the same date of service.
- The NCS and needle EMG exam results should be integrated into a unifying report and diagnostic impression.
Cross-references:
- MP 2.096 Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
- MP 2.097 Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain
Product variations
This policy is only applicable to certain programs and products administered by Capital Blue Cross and subject to benefit variations. Please see additional information below.
FEP PPO - Refer to FEP Medical Policy Manual.
Description/Background
Electrodiagnostic Assessment
Electromyography (EMG) and nerve conduction study (NCS) are used as adjuncts to clinical evaluation of myopathy and peripheral neuropathy. These tests intend to evaluate the integrity and electrical function of muscles and peripheral nerves. They are performed when there is clinical suspicion for a myopathic or neuropathic process and when clinical examination and standard laboratory testing cannot make a definitive diagnosis.
Test results do not generally provide a specific diagnosis. Rather, they provide additional information that assists physicians in characterizing a clinical syndrome. EMG/NCS may be useful when there is no clear etiology when symptoms are severe or rapidly progressing, or when symptoms are atypical (e.g., asymmetrical, acute onset, or appearing to be autonomic).
According to the American Association of Neuromuscular and Electrodiagnostic Medicine (2023), electrodiagnostic assessment has the following goals:
- “Identify normal and abnormal nerve, muscle, motor or sensory neuron, and NMJ [neuromuscular junction] functioning.
- Localize region(s) of pathology.
- Characterize the pathology.
- Determine the distribution of abnormalities.
- Determine the severity of abnormalities.
- Estimate the chronology of the disease.
- Determine the progression and/or recovery from abnormal function.
- Aid in diagnosis and prognosis of disease.
- Aid in selecting treatment options.
- Aid in following response to treatment by providing objective evidence of change in NM [neuromuscular] function.
- Localize correct locations for injections of intramuscular agents….”
Components of the electrodiagnostic exam may include needle EMG, NCS, repetitive nerve stimulation study, somatosensory evoked potentials, and blink reflexes.
Electromyography
Needle EMG
An EMG needle electrode is inserted into selected muscles, chosen by the examining physician depending on the differential diagnosis and other information available during the exam. The response of the muscle to electrical stimulation is recorded. Three components are evaluated: observation at rest, action potential with minimal voluntary contraction, and action potential with maximum contraction.
Single Fiber EMG
In single fiber EMG, a needle electrode records the response of a single muscle fiber. This test can evaluate “jitter,” which is defined as the variability in time between activation of the nerve and generation of the muscle action potential. Single fiber EMG can also measure fiber density, which is defined as the mean number of muscle fibers for 1 motor unit.
Nerve Conduction Study
In NCS, both motor and sensory nerve conduction are assessed. For motor conduction, electrical stimuli are delivered along various points on the nerve, and the electrical response is recorded from the appropriate muscle. For sensory conduction, electrical stimuli are delivered to 1 point on the nerve and the response recorded at a distal point on the nerve. Parameters recorded include velocity, amplitude, latency, and configuration.
Late Wave Responses
Late waves are a complement to the basic NCS and evaluate the functioning of the proximal segment of peripheral nerves, such as the nerve root and the anterior horn cells. There are 2 types of late responses: the H-reflex and the F wave.
The H-reflex is elicited by stimulating the posterior tibial nerve and measuring the response in the gastrocnemius muscle. It is analogous to the ankle reflex and can be prolonged by radiculopathy at S1 or by peripheral neuropathy.
The F wave is assessed by supramaximal stimulation of the distal nerve and can help estimate the conduction velocity in the proximal portion of the nerve. This will provide information on the presence of proximal nerve abnormalities, such as radiculopathy or plexopathy.
Repetitive Nerve Stimulation
Repetitive nerve stimulation studies evaluate the integrity and function of the neuromuscular junction. The test involves stimulating a nerve repetitively at variable rates and recording the response of the corresponding muscle(s). Disorders of the neuromuscular junction will show a diminished muscular response to repetitive stimulation.
Somatosensory Evoked Potentials
Somatosensory evoked potentials evaluate nerve conduction in various sensory fibers of both the peripheral and central nervous system and test the integrity and function of these nerve pathways. They are typically used to assess nerve conduction in the spinal cord and other central pathways that cannot be assessed by standard NCS.
Blink Reflexes
The blink reflexes, which are analogs of the corneal reflex, are evaluated by stimulating the orbicularis orbis muscle at the lower eyelid. They are used to localize lesions in the fifth or seventh cranial nerves.
Differential Diagnosis
The specific components of an individual test are not standardized. Rather, a differential diagnosis is developed by the treating physician, and/or the clinician performing the test, and the specific components of the exam are determined by the disorders being considered in the differential. Also, the differential diagnosis may be modified during the exam to reflect initial findings, and this may also influence the specific components included in the final analysis.
Automated Point-of-Care Nerve Conduction Tests
Portable devices have been developed to provide point-of-care (POC) nerve conduction studies (NCSs). These devices have computational algorithms that can drive stimulus delivery, measure and analyze the response, and report study results. Automated nerve conduction could be used in various settings, including primary care, without the need for specialized training or equipment.
Electrodiagnostic Testing
Nerve conduction studies (NCSs) and needle electromyography (EMG), when properly performed by a trained practitioner, are considered the criterion standard of electrodiagnostic testing for the evaluation of focal and generalized disorders of peripheral nerves. However, the need for specialized equipment and personnel may limit the availability of electrodiagnostic testing for some patients.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a pressure-induced entrapment neuropathy of the median nerve as it passes through the carpal tunnel, resulting in sensorimotor disturbances. This syndrome is defined by its characteristic clinical symptoms, which may include pain, subjective feelings of swelling, and nocturnal paresthesia.
Diagnosis
A variety of simple diagnostic tools are available, and a positive response to conservative management (steroid injection, splints, modification of activity) can confirm the clinical diagnosis. Electrodiagnostic studies may also be used to confirm the presence or absence of median neuropathy at the wrist, assess the severity of the neuropathy, and assess associated diagnoses. Nerve conduction is typically assessed before the surgical release of the carpal tunnel, but the use of EMG in the diagnosis of carpal tunnel syndrome is controversial. One proposed use of automated nerve conduction devices is to assist in the diagnosis of carpal tunnel syndrome.
Lumbosacral Radiculopathy
Electrodiagnostic studies are useful in the evaluation of lumbosacral radiculopathy in the presence of disabling symptoms of radiculopathy or neuromuscular weakness. These tests are most commonly considered in patients with persistent disabling symptoms when neuroimaging findings are inconsistent with clinical presentation. Comparisons of automated point-of-care (POC) NCSs with EMGs and standardized NCSs have been evaluated as alternative electrodiagnostic tools.
Peripheral Neuropathy
Peripheral neuropathy is relatively common in patients with diabetes, and the diagnosis is often made clinically through physical examination. Diabetic peripheral neuropathy can lead to morbidity including pain, foot deformity, and foot ulceration.
Diagnosis
Clinical practice guidelines have recommended using simple sensory tools such as the 10-g Semmes-Weinstein monofilament or the 128-Hz vibration tuning fork for diagnosis. These simple tests predict the presence of neuropathy defined by electrophysiologic criteria with a high level of accuracy. Electrophysiologic testing may be used in research studies and may be required in cases with an atypical presentation. POC nerve conduction testing has been proposed as an alternative to standard electrodiagnostic methods for the diagnosis of peripheral neuropathy and, in particular, for detecting neuropathy in patients with diabetes.
Normative Values
NeuroMetrix (2009) published reference ranges for key nerve conduction parameters in healthy subjects. Data analyzed were pooled from 5 studies, including from 92 to 848 healthy subjects with data on the median, ulnar, peroneal, tibial, and sural nerves. Subject age and height were found to affect the parameters. In addition to providing reference ranges for clinicians to use (providing that NCS techniques are consistent with those described in the article), the authors stated that clinicians could use the same method to develop their own reference ranges. At this time, the proposed reference ranges have not been validated in a clinical patient population.
Due to the lack of uniform standards in nerve conduction testing in the United States, the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) identified 7 criteria that would identify high-quality NCS articles that would be appropriate for using as referent standards (2016). AANEM identified normative criteria for nerve conduction velocity tests based on a review of high-quality published studies (see Table 1). In March 2017, the American Academy of Neurology affirmed AANEM’s recommendations.
Table 1. Criteria for Evaluating Published Sources for Normative Standards
Criteria |
Description |
|
Year published |
Published during or after 1990, written in or translated from other languages into English |
|
Sample size |
>100 normal subjects |
|
Subjects |
Inclusion and exclusion criteria must be methodologically sound and reflect a true “normal” group of asymptomatic individuals |
|
Testing factors |
|
|
Age |
Wide distribution of subject ages >18 years with adequate sampling of the elderly |
|
Statistical analyses |
|
|
Data presentation |
Reference values and cutoff points for NCS parameters clearly presented in a useful format |
Adapted from Dillingham et al (2016).
Chen (2016) published reference values for upper and lower NCSs in adults, as a companion study to the Dillingham et al (2016) report (above), to address the need for greater standardization in the field of electrodiagnostic medicine. Using the consensus-based criteria developed by AANEM, a comprehensive literature search was conducted for 11 routinely performed sensory and motor NCS from 1990 to 2012. Over 7500 articles were found, but after review, a single acceptable study meeting all criteria was identified for the 11 nerves. Reviewers determined there were multifactorial reasons that so few studies met the criteria. Large-scale normative studies are time intensive, requiring significant resources and cost. Data from many studies did not address the non-Gaussian distribution of NCS parameters and often derived cutoff values using the mean and standard deviations rather than percentiles.
Regulatory status
EMG/NCS measure nerve and muscle function and may be indicated when evaluating limb pain, weakness related to possible spinal nerve compression, or other neurologic injury or disorder. A number of electromyographic devices have received marketing clearance by the U.S. Food and Drug Administration (FDA). Several devices are listed in Table 1.
Table 1. Electromyographic Devices Approved by FDA
Device |
Manufacturer |
FDA clearance |
510(k) No. |
FDA product code |
|
NuVasive® NVM5 System |
NuVasive |
2011 |
K112718 |
ETN |
|
CERSR® Electromyography System |
SpineMatrix |
2011 |
K110048 |
IKN |
|
CareFusion Nicolet® EDX |
CareFusion 209 |
2012 |
K120979 |
GWF |
|
Physical Monitoring Registration Unit-S (PMRU-S) |
Oktx |
2013 |
K123902 |
IKN |
|
MyoVision 3G Wirefree™ System |
Precision Biometrics |
2013 |
K123399 |
IKN |
|
Neuro Omega™ System |
Alpha Omega Engineering |
2013 |
K123796 |
GZL |
|
EPAD™ |
SafeOp Surgical |
2014 |
K132616 |
GWF |
|
Sierra Summit, Sierra Ascent |
Cadwell Industries |
2017 |
K162383 |
IKN, GWF |
|
EPAD 2™ |
SafeOp Surgical |
2019 |
K182542 |
GWF, IKN |
|
Mediracer® NCS |
Mediracer |
2019 |
K190536 |
JXE, IKN |
|
Mega-TMS™ |
Soterix Medical, Inc. |
2021 |
K192823 |
GWF, JXE |
|
SafeOp 3: Neural Informatix System |
Alphatec Spine, Inc |
2024 |
K234092 |
IKN, GWF, GXZ, GXY, ETN, PDQ |
FDA: Food and Drug Administration
Multiple devices have been cleared for POC neural conduction testing. For example, in 1986, Neurometer® CPT/C® (Neurotron®) was cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process (K853608). The device evaluates and documents sensory nerve impairments at cutaneous or mucosal sites. The evaluation detects and quantifies hyperesthesia in early stages of progressive neuropathy and hypoesthesia in more advanced conditions.
In 1998 NC-stat® (NeuroMetrix) was cleared by FDA through the 510(k) process (K982359). NC-stat® is intended “to measure neuromuscular signals that are useful in diagnosing and evaluating systemic and entrapment neuropathies.” This version is no longer commercially available. It is the predicate device for the NC-stat DPNCheck® (K041320), cleared in 2004, and the NeuroMetrix Advance (K070109), cleared in 2008. The NC-stat DPNCheck device measures the sural nerve conduction velocity and sensory nerve action potential amplitude. It is a handheld device with an infrared thermometer, non-invasive electrical stimulation probes, and a single-use biosensor for each test. NC-stat DPNCheck is designed specifically for NCS of the sural nerve in the assessment of diabetic peripheral neuropathy. The NeuroMetrix ADVANCE is a POC test that can be used to perform needle EMG in addition to surface electrodes for the performance of NCSs. If the needle EMG module is used, then the device is also intended to measure signals useful in evaluating disorders of muscles.
On January 23, 2017, Cadwell Sierra Summit and Cadwell Sierra Ascent (Cadwell Industries) was cleared for marketing by FDA through the 510(k) process (K162383). There are portable laptop versions and a desktop application with a handheld device. The system is used for acquisition, display, storage, transmission, analysis, and reporting of electrophysiologic and environmental data including EMG, NCS, evoked potentials, and autonomic responses (RR interval variability). The Cadwell Sierra Summit is used to detect the physiologic function of the nervous system, and to support the diagnosis of neuromuscular diseases or conditions.
FDA product code: JXE.
Table 2. Select FDA-Cleared Devices for Neural Conduction Testing
Device |
Manufacturer |
Date cleared |
510(k) |
Indications |
|
Axon II™ |
PainDX |
1998 |
K980866 |
Part of a routine neurologic exam or screening procedure to detect peripheral neuropathy, which may be caused by various pathologic conditions or exposures to toxic substances |
|
Brevio® |
Neurotron Medical |
2001 |
K012069 |
To measure nerve response latency and amplitude in the diagnosis and monitoring of peripheral neuropathies |
|
NC-stat®, NC-stat DPNCheck |
NeuroMetrix |
2004 |
K041320 |
To stimulate and measure neuromuscular signals in diagnosing and evaluating systemic and entrapment neuropathies. Added the sural biosensor for use in diagnosing neuropathies affecting the sural nerve. |
|
NC-stat® |
NeuroMetrix |
2006 |
K060584 |
Addition of the modified median motor-sensory biosensor to stimulate and measure neuromuscular signals useful in diagnosing and evaluating systemic and entrapment neuropathies |
|
NeuroMetrix Advance™ |
NeuroMetrix |
2008 |
K070109 |
To measure neuromuscular signals useful as an aid in diagnosing and evaluating patients suspected of having focal or systemic neuropathies. If the elective needle EMG module is used, then the device is also intended to measure signals useful as an aid in evaluating disorders of muscles. |
|
XLTEK NEUROPATH |
Excel Tech |
2006 |
K053058 |
To stimulate and measure neuromuscular signals useful in diagnosing and evaluating systemic and entrapment neuropathies |
Rationale
Summary of evidence
For individuals with suspected peripheral neuropathy or myopathy who receive electrodiagnostic assessment including EMG and NCS, the evidence includes small observational studies on a few diagnoses, such as carpal tunnel syndrome, radiculopathy, and myopathy. Relevant outcomes are test accuracy, symptoms, functional outcomes, and quality of life. Because electrodiagnostic assessment is considered the criterion standard for evaluating the electrical function of peripheral nerves and muscles, there is no true alternative reference standard against which the sensitivity and specificity of particular EMG/NCS abnormalities for particular clinical disorders can be calculated. Different studies have used different reference standards, such as EMG/NCS measures of healthy individuals or clinical examination results. In general, these tests are considered more specific than sensitive, and normal results do not rule out disease. The limited evidence has shown a wide range of sensitivities, which are often less than 50%. The specificity is expected to be considerably higher, but the data are insufficient to provide precise estimates of either sensitivity or specificity. The evidence is insufficient to determine the effects of the technology on health outcomes.
For individuals who have entrapment carpal tunnel syndrome who received automated POC NCSs, the evidence includes studies on the diagnostic accuracy and clinical outcomes from industry-sponsored trials, nonrandomized trials, and registry data. Relevant outcomes are test accuracy and validity, symptoms, and functional outcomes. Four RCTs have reported on the diagnostic accuracy of automated POC nerve conduction testing for carpal tunnel syndrome. Sensitivity testing has suggested there could be diagnostic value in detecting carpal tunnel syndrome; specificity testing was inconsistent across trials. No reference ranges were validated, and normative values were not defined in these studies. No validation testing by trained medical assistants vs trained specialist was reported in the studies. The evidence on clinical outcomes is limited to a single nonrandomized clinical trial and NeuroMetrix registry data. Neither reported health outcomes assessing patient symptoms or changes in functional status. The evidence is insufficient to determine the effects of the technology on health outcomes.
For individuals with lumbosacral radiculopathy who received automated POC NCSs, the evidence includes industry-sponsored trials and a nonrandomized study of diagnostic accuracy. Relevant outcomes are test accuracy and validity, symptoms, and functional outcomes. The evidence on the diagnostic accuracy of POC NCS in this population has shown variable test results across reported trials. No normative values were defined. Weaknesses of the studies included lack of applicable or valid reference ranges for testing, and variable test results validating or confirming pathology. The results of the 2 studies on diagnostic performance were inconclusive, with high false-positive results in a single trial. No trials on health outcomes assessing patient symptoms or changes in functional status were identified. The evidence is insufficient to determine the effects of the technology on health outcomes.
For individuals with diabetic peripheral neuropathy who received automated POC NCSs, the evidence includes industry-sponsored observational trials and nonrandomized studies on the diagnostic accuracy. Relevant outcomes are test accuracy and validity, symptoms, and functional outcomes. Of 3 studies reporting evidence on diagnostic accuracy, 2 used NC-stat DPNCheck. Sensitivity testing has suggested there could be diagnostic value in detecting diabetic peripheral neuropathy in symptomatic patients; the evidence to detect patients who are suspected of disease but who have mild symptoms was inconsistent. No reference ranges were validated, and normative values were not defined in 2 of the 3 studies. No validation testing by trained medical assistants vs trained specialist was reported in the studies. No trials on health outcomes assessing patient symptoms or changes in functional status were identified. The evidence is insufficient to determine the effects of the technology on health outcomes.
Definitions
510(k) is a premarketing submission made to FDA to demonstrate that the device to be marketed is as safe and effective, that is, substantially equivalent (SE), to a legally marketed device that is not subject to premarket approval (PMA). Applicants must compare their 510(k) device to one or more similar devices currently on the U.S. market and make and support their substantial equivalency claims.
Neuropathy refers to any disease of the nerves.
Peripheral refers to something that occurs away from the center.
Disclaimer
Capital Blue Cross’ medical policies are used to determine coverage for specific medical technologies, procedures, equipment, and services. These medical policies do not constitute medical advice and are subject to change as permitted by law or applicable clinical evidence from independent treatment guidelines. Treating providers are solely responsible for medical advice and treatment of members. These policies are not a guarantee of coverage or payment. Payment of claims is subject to a determination regarding the member’s benefit program and eligibility on the date of service, and a determination that the services are medically necessary and appropriate. Final processing of a claim is based upon the terms of contract that applies to the members’ benefit program, including benefit limitations and exclusions. If a provider or a member has a question concerning this medical policy, please contact Capital Blue Cross’ Provider Services or Member Services.
Coding information
Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement.
Investigational; therefore, not covered:
Procedure codes |
||||
|
95905 |
95999 |
G0255 |
|
|
Covered when medically necessary:
Procedure codes |
||||
|
92265 |
95860 |
95861 |
95863 |
95864 |
|
95865 |
95866 |
95867 |
95868 |
95869 |
|
95870 |
95872 |
95874 |
95885 |
95886 |
|
95887 |
95907 |
95908 |
95909 |
95910 |
|
95911 |
95912 |
95913 |
95937 |
|
ICD-10-CM diagnosis code |
Description |
|
A14.139A |
Anterior cord syndrome at unspecified level of cervical spinal cord, initial encounter |
|
A52.15 |
Late syphilitic neuropathy |
|
E08.41 |
Diabetes mellitus due to underlying condition with diabetic mononeuropathy |
|
E08.42 |
Diabetes mellitus due to underlying condition with diabetic polyneuropathy |
|
E08.43 |
Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy |
|
E08.44 |
Diabetes mellitus due to underlying condition with diabetic amyotrophy |
|
E08.49 |
Diabetes mellitus due to underlying condition with other diabetic neurological complication |
|
E08.610 |
Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy |
|
E09.41 |
Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy |
|
E09.42 |
Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy |
|
E09.43 |
Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy |
|
E09.44 |
Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy |
|
E09.49 |
Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication |
|
E09.610 |
Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy |
|
E10.40 |
Type 1 diabetes mellitus with diabetic neuropathy, unspecified |
|
E10.41 |
Type 1 diabetes mellitus with diabetic mononeuropathy |
|
E10.42 |
Type 1 diabetes mellitus with diabetic polyneuropathy |
|
E10.43 |
Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy |
|
E10.44 |
Type 1 diabetes mellitus with diabetic amyotrophy |
|
E10.49 |
Type 1 diabetes mellitus with other diabetic neurological complication |
|
E10.610 |
Type 1 diabetes mellitus with diabetic neuropathic arthropathy |
|
E11.40 |
Type 2 diabetes mellitus with diabetic neuropathy, unspecified |
|
E11.41 |
Type 2 diabetes mellitus with diabetic mononeuropathy |
|
E11.42 |
Type 2 diabetes mellitus with diabetic polyneuropathy |
|
E11.43 |
Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy |
|
E11.44 |
Type 2 diabetes mellitus with diabetic amyotrophy |
|
E11.49 |
Type 2 diabetes mellitus with other diabetic neurological complication |
|
E11.610 |
Type 2 diabetes mellitus with diabetic neuropathic arthropathy |
|
E13.41 |
Other specified diabetes mellitus with diabetic mononeuropathy |
|
E13.42 |
Other specified diabetes mellitus with diabetic polyneuropathy |
|
E13.43 |
Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy |
|
E13.44 |
Other specified diabetes mellitus with diabetic amyotrophy |
|
E13.49 |
Other specified diabetes mellitus with other diabetic neurological complication |
|
E13.610 |
Other specified diabetes mellitus with diabetic neuropathic arthropathy |
|
G12.20 |
Motor neuron disease, unspecified |
|
G12.21 |
Amyotrophic lateral sclerosis |
|
G12.22 |
Progressive bulbar palsy |
|
G12.23 |
Primary lateral sclerosis |
|
G12.24 |
Familial motor neuron disease |
|
G12.25 |
Progressive spinal muscle atrophy |
|
G12.29 |
Other motor neuron disease |
|
G12.8 |
Other spinal muscular atrophies and related syndromes |
|
G12.9 |
Spinal muscular atrophy, unspecified |
|
G13.0 |
Paraneoplastic neuromyopathy and neuropathy |
|
G13.1 |
Other systemic atrophy primarily affecting central nervous system in neoplastic disease |
|
G54.0 |
Brachial plexus disorders |
|
G54.1 |
Lumbosacral plexus disorders |
|
G54.2 |
Cervical root disorders, not elsewhere classified |
|
G54.3 |
Thoracic root disorders, not elsewhere classified |
|
G54.4 |
Lumbosacral root disorders, not elsewhere classified |
|
G54.5 |
Neuralgic amyotrophy |
|
G54.6 |
Phantom limb syndrome with pain |
|
G54.7 |
Phantom limb syndrome without pain |
|
G54.8 |
Other nerve root and plexus disorders |
|
G54.9 |
Nerve root and plexus disorder, unspecified |
|
G55 |
Nerve root and plexus compressions in diseases classified elsewhere |
|
G56.00 |
Carpal tunnel syndrome, unspecified upper limb |
|
G56.01 |
Carpal tunnel syndrome, right upper limb |
|
G56.02 |
Carpal tunnel syndrome, left upper limb |
|
G56.03 |
Carpal tunnel syndrome, bilateral upper limbs |
|
G56.10 |
Other lesions of median nerve, unspecified upper limb |
|
G56.11 |
Other lesions of median nerve, right upper limb |
|
G56.12 |
Other lesions of median nerve, left upper limb |
|
G56.13 |
Other lesions of median nerve, bilateral upper limbs |
|
G56.20 |
Lesion of ulnar nerve, unspecified upper limb |
|
G56.21 |
Lesion of ulnar nerve, right upper limb |
|
G56.22 |
Lesion of ulnar nerve, left upper limb |
|
G56.23 |
Lesion of ulnar nerve, bilateral upper limbs |
|
G56.31 |
Lesion of radial nerve, right upper limb |
|
G56.32 |
Lesion of radial nerve, left upper limb |
|
G56.33 |
Lesion of radial nerve, bilateral upper limbs |
|
G56.41 |
Causalgia of right upper limb |
|
G56.42 |
Causalgia of left upper limb |
|
G56.43 |
Causalgia of bilateral upper limbs |
|
G56.81 |
Other specified mononeuropathies of right upper limb |
|
G56.82 |
Other specified mononeuropathies of left upper limb |
|
G56.83 |
Other specified mononeuropathies of bilateral upper limbs |
|
G56.91 |
Unspecified mononeuropathy of right upper limb |
|
G56.92 |
Unspecified mononeuropathy of left upper limb |
|
G56.93 |
Unspecified mononeuropathy of bilateral upper limbs |
|
G57.00 |
Lesion of sciatic nerve, unspecified lower limb |
|
G57.01 |
Lesion of sciatic nerve, right lower limb |
|
G57.02 |
Lesion of sciatic nerve, left lower limb |
|
G57.03 |
Lesion of sciatic nerve, bilateral lower limbs |
|
G57.10 |
Meralgia paresthetica, unspecified lower limb |
|
G57.11 |
Meralgia paresthetica, right lower limb |
|
G57.12 |
Meralgia paresthetica, left lower limb |
|
G57.13 |
Meralgia paresthetica, bilateral lower limbs |
|
G57.20 |
Lesion of femoral nerve, unspecified lower limb |
|
G57.21 |
Lesion of femoral nerve, right lower limb |
|
G57.22 |
Lesion of femoral nerve, left lower limb |
|
G57.23 |
Lesion of femoral nerve, bilateral lower limbs |
|
G57.30 |
Lesion of lateral popliteal nerve, unspecified lower limb |
|
G57.31 |
Lesion of lateral popliteal nerve, right lower limb |
|
G57.32 |
Lesion of lateral popliteal nerve, left lower limb |
|
G57.33 |
Lesion of lateral popliteal nerve, bilateral lower limbs |
|
G57.40 |
Lesion of medial popliteal nerve, unspecified lower limb |
|
G57.41 |
Lesion of medial popliteal nerve, right lower limb |
|
G57.42 |
Lesion of medial popliteal nerve, left lower limb |
|
G57.43 |
Lesion of medial popliteal nerve, bilateral lower limbs |
|
G57.50 |
Tarsal tunnel syndrome, unspecified lower limb |
|
G57.51 |
Tarsal tunnel syndrome, right lower limb |
|
G57.52 |
Tarsal tunnel syndrome, left lower limb |
|
G57.53 |
Tarsal tunnel syndrome, bilateral lower limbs |
|
G57.60 |
Lesion of plantar nerve, unspecified lower limb |
|
G57.61 |
Lesion of plantar nerve, right lower limb |
|
G57.62 |
Lesion of plantar nerve, left lower limb |
|
G57.63 |
Lesion of plantar nerve, bilateral lower limbs |
|
G57.70 |
Causalgia of unspecified lower limb |
|
G57.71 |
Causalgia of right lower limb |
|
G57.72 |
Causalgia of left lower limb |
|
G57.73 |
Causalgia of bilateral lower limbs |
|
G57.80 |
Other specified mononeuropathies of unspecified lower limb |
|
G57.81 |
Other specified mononeuropathies of right lower limb |
|
G57.82 |
Other specified mononeuropathies of left lower limb |
|
G57.83 |
Other specified mononeuropathies of bilateral lower limbs |
|
G57.90 |
Unspecified mononeuropathy of unspecified lower limb |
|
G57.91 |
Unspecified mononeuropathy of right lower limb |
|
G57.92 |
Unspecified mononeuropathy of left lower limb |
|
G57.93 |
Unspecified mononeuropathy of bilateral lower limbs |
|
G58.0 |
Intercostal neuropathy |
|
G58.7 |
Mononeuritis multiplex |
|
G58.9 |
Mononeuropathy, unspecified |
|
G59 |
Mononeuropathy in diseases classified elsewhere |
|
G60.0 |
Hereditary motor and sensory neuropathy |
|
G60.1 |
Refsum's disease |
|
G60.2 |
Neuropathy in association with hereditary ataxia |
|
G60.3 |
Idiopathic progressive neuropathy |
|
G60.8 |
Other hereditary and idiopathic neuropathies |
|
G60.9 |
Hereditary and idiopathic neuropathy, unspecified |
|
G61.0 |
Guillain-Barre syndrome |
|
G61.1 |
Serum neuropathy |
|
G61.81 |
Chronic inflammatory demyelinating polyneuritis |
|
G61.82 |
Multifocal motor neuropathy |
|
G61.89 |
Other inflammatory polyneuropathies |
|
G61.9 |
Inflammatory polyneuropathy, unspecified |
|
G62.0 |
Drug-induced polyneuropathy |
|
G62.1 |
Alcoholic polyneuropathy |
|
G62.2 |
Polyneuropathy due to other toxic agents |
|
G62.81 |
Critical illness polyneuropathy |
|
G62.82 |
Radiation-induced polyneuropathy |
|
G62.89 |
Other specified polyneuropathies |
|
G62.9 |
Polyneuropathy, unspecified |
|
G63 |
Polyneuropathy in diseases classified elsewhere |
|
G64 |
Other disorders of peripheral nervous system |
|
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 |
|
G71.00 |
Muscular dystrophy, unspecified |
|
G71.01 |
Duchenne or Becker muscular dystrophy |
|
G71.02 |
Facioscapulohumeral muscular dystrophy |
|
G71.036 |
Limb girdle muscular dystrophy due to fukutin related protein dysfunction |
|
G71.09 |
Other specified muscular dystrophies |
|
G71.11 |
Myotonic muscular dystrophy |
|
G71.12 |
Myotonia congenita |
|
G71.13 |
Myotonic chondrodystrophy |
|
G71.14 |
Drug induced myotonia |
|
G71.19 |
Other specified myotonic disorders |
|
G71.20 |
Congenital myopathies, unspecified |
|
G71.21 |
Nemaline myopathy |
|
G71.220 |
X-Linked myotubular myopathy |
|
G71.228 |
Other centronuclear myopathy |
|
G71.29 |
Other congenital myopathy |
|
G71.3 |
Mitochondrial myopathy, not elsewhere classified |
|
G71.8 |
Other primary disorders of muscles |
|
G71.9 |
Primary disorder of muscle, unspecified |
|
G72.0 |
Drug-induced myopathy |
|
G72.1 |
Alcoholic myopathy |
|
G72.2 |
Myopathy due to other toxic agents |
|
G72.3 |
Periodic paralysis |
|
G72.41 |
Inclusion body myositis [IBM] |
|
G72.49 |
Other inflammatory and immune myopathies, not elsewhere classified |
|
G72.81 |
Critical illness myopathy |
|
G72.89 |
Other specified myopathies |
|
G72.9 |
Myopathy, unspecified |
|
G73.1 |
Lambert-Eaton syndrome in neoplastic disease |
|
G73.3 |
Myasthenic syndromes in other diseases classified elsewhere |
|
G73.7 |
Myopathy in diseases classified elsewhere |
|
G90.01 |
Carotid sinus syncope |
|
G90.09 |
Other idiopathic peripheral autonomic neuropathy |
|
G90.2 |
Horner's syndrome |
|
G90.4 |
Autonomic dysreflexia |
|
G90.511 |
Complex regional pain syndrome I of right upper limb |
|
G90.512 |
Complex regional pain syndrome I of left upper limb |
|
G90.513 |
Complex regional pain syndrome I of upper limb, bilateral |
|
G90.521 |
Complex regional pain syndrome I of right lower limb |
|
G90.522 |
Complex regional pain syndrome I of left lower limb |
|
G90.523 |
Complex regional pain syndrome I of lower limb, bilateral |
|
G90.59 |
Complex regional pain syndrome I of other specified site |
|
G90.8 |
Other disorders of autonomic nervous system |
|
G90.9 |
Disorder of the autonomic nervous system, unspecified |
|
G99.0 |
Autonomic neuropathy in diseases classified elsewhere |
|
M05.411 |
Rheumatoid myopathy with rheumatoid arthritis of right shoulder |
|
M05.412 |
Rheumatoid myopathy with rheumatoid arthritis of left shoulder |
|
M05.421 |
Rheumatoid myopathy with rheumatoid arthritis of right elbow |
|
M05.422 |
Rheumatoid myopathy with rheumatoid arthritis of left elbow |
|
M05.431 |
Rheumatoid myopathy with rheumatoid arthritis of right wrist |
|
M05.432 |
Rheumatoid myopathy with rheumatoid arthritis of left wrist |
|
M05.441 |
Rheumatoid myopathy with rheumatoid arthritis of right hand |
|
M05.442 |
Rheumatoid myopathy with rheumatoid arthritis of left hand |
|
M05.451 |
Rheumatoid myopathy with rheumatoid arthritis of right hip |
|
M05.452 |
Rheumatoid myopathy with rheumatoid arthritis of left hip |
|
M05.461 |
Rheumatoid myopathy with rheumatoid arthritis of right knee |
|
M05.462 |
Rheumatoid myopathy with rheumatoid arthritis of left knee |
|
M05.471 |
Rheumatoid myopathy with rheumatoid arthritis of right ankle and foot |
|
M05.472 |
Rheumatoid myopathy with rheumatoid arthritis of left ankle and foot |
|
M05.49 |
Rheumatoid myopathy with rheumatoid arthritis of multiple sites |
|
M05.511 |
Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder |
|
M05.512 |
Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder |
|
M05.521 |
Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow |
|
M05.522 |
Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow |
|
M05.531 |
Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist |
|
M05.532 |
Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist |
|
M05.541 |
Rheumatoid polyneuropathy with rheumatoid arthritis of right hand |
|
M05.542 |
Rheumatoid polyneuropathy with rheumatoid arthritis of left hand |
|
M05.551 |
Rheumatoid polyneuropathy with rheumatoid arthritis of right hip |
|
M05.552 |
Rheumatoid polyneuropathy with rheumatoid arthritis of left hip |
|
M05.561 |
Rheumatoid polyneuropathy with rheumatoid arthritis of right knee |
|
M05.562 |
Rheumatoid polyneuropathy with rheumatoid arthritis of left knee |
|
M05.571 |
Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot |
|
M05.572 |
Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot |
|
M05.59 |
Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites |
|
M33.00 |
Juvenile dermatomyositis, organ involvement unspecified |
|
M33.01 |
Juvenile dermatomyositis with respiratory involvement |
|
M33.02 |
Juvenile dermatomyositis with myopathy |
|
M33.03 |
Juvenile dermatomyositis without myopathy |
|
M33.09 |
Juvenile dermatomyositis with other organ involvement |
|
M33.10 |
Other dermatomyositis, organ involvement unspecified |
|
M33.11 |
Other dermatomyositis with respiratory involvement |
|
M33.12 |
Other dermatomyositis with myopathy |
|
M33.13 |
Other dermatomyositis without myopathy |
|
M33.19 |
Other dermatomyositis with other organ involvement |
|
M33.20 |
Polymyositis, organ involvement unspecified |
|
M33.21 |
Polymyositis with respiratory involvement |
|
M33.22 |
Polymyositis with myopathy |
|
M33.29 |
Polymyositis with other organ involvement |
|
M33.90 |
Dermatopolymyositis, unspecified, organ involvement unspecified |
|
M33.91 |
Dermatopolymyositis, unspecified with respiratory involvement |
|
M33.92 |
Dermatopolymyositis, unspecified with myopathy |
|
M33.93 |
Dermatopolymyositis, unspecified without myopathy |
|
M33.99 |
Dermatopolymyositis, unspecified with other organ involvement |
|
M34.82 |
Systemic sclerosis with myopathy |
|
M34.83 |
Systemic sclerosis with polyneuropathy |
|
M35.03 |
Sicca syndrome with myopathy |
|
M36.0 |
Dermato(poly)myositis in neoplastic disease |
|
M51.14 |
Intervertebral disc disorders with radiculopathy, thoracic region |
|
M51.15 |
Intervertebral disc disorders with radiculopathy, thoracolumbar region |
|
M51.16 |
Intervertebral disc disorders with radiculopathy, lumbar region |
|
M51.17 |
Intervertebral disc disorders with radiculopathy, lumbosacral region |
|
M54.10 |
Radiculopathy, site unspecified |
|
M54.11 |
Radiculopathy, occipito-atlanto-axial region |
|
M54.12 |
Radiculopathy, cervical region |
|
M54.13 |
Radiculopathy, cervicothoracic region |
|
M54.14 |
Radiculopathy, thoracic region |
|
M54.15 |
Radiculopathy, thoracolumbar region |
|
M54.16 |
Radiculopathy, lumbar region |
|
M54.17 |
Radiculopathy, lumbosacral region |
|
M54.18 |
Radiculopathy, sacral and sacrococcygeal region |
|
S04.10XA |
Injury of oculomotor nerve, unspecified side, initial encounter |
|
S04.11XA |
Injury of oculomotor nerve, right side, initial encounter |
|
S04.12XA |
Injury of oculomotor nerve, left side, initial encounter |
|
S04.21XA |
Injury of trochlear nerve, right side, initial encounter |
|
S04.22XA |
Injury of trochlear nerve, left side, initial encounter |
|
S04.31XA |
Injury of trigeminal nerve, right side, initial encounter |
|
S04.32XA |
Injury of trigeminal nerve, left side, initial encounter |
|
S04.41XA |
Injury of abducent nerve, right side, initial encounter |
|
S04.42XA |
Injury of abducent nerve, left side, initial encounter |
|
S04.51XA |
Injury of facial nerve, right side, initial encounter |
|
S04.52XA |
Injury of facial nerve, left side, initial encounter |
|
S04.61XA |
Injury of acoustic nerve, right side, initial encounter |
|
S04.62XA |
Injury of acoustic nerve, left side, initial encounter |
|
S04.71XA |
Injury of accessory nerve, right side, initial encounter |
|
S04.72XA |
Injury of accessory nerve, left side, initial encounter |
|
S04.811A |
Injury of olfactory [1st] nerve, right side, initial encounter |
|
S04.812A |
Injury of olfactory [1st] nerve, left side, initial encounter |
|
S04.891A |
Injury of other cranial nerves, right side, initial encounter |
|
S04.892A |
Injury of other cranial nerves, left side, initial encounter |
|
S04.9XXA |
Injury of unspecified cranial nerve, initial encounter |
|
S12.000A |
Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture |
|
S12.000B |
Unspecified displaced fracture of first cervical vertebra, initial encounter for open fracture |
|
S12.001A |
Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture |
|
S12.001B |
Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture |
|
S12.100A |
Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture |
|
S12.100B |
Unspecified displaced fracture of second cervical vertebra, initial encounter for open fracture |
|
S12.101A |
Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture |
|
S12.101B |
Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for open fracture |
|
S12.200A |
Unspecified displaced fracture of third cervical vertebra, initial encounter for closed fracture |
|
S12.200B |
Unspecified displaced fracture of third cervical vertebra, initial encounter for open fracture |
|
S12.201A |
Unspecified nondisplaced fracture of third cervical vertebra, initial encounter for closed fracture |
|
S12.201B |
Unspecified nondisplaced fracture of third cervical vertebra, initial encounter for open fracture |
|
S12.300A |
Unspecified displaced fracture of fourth cervical vertebra, initial encounter for closed fracture |
|
S12.300B |
Unspecified displaced fracture of fourth cervical vertebra, initial encounter for open fracture |
|
S12.301A |
Unspecified nondisplaced fracture of fourth cervical vertebra, initial encounter for closed fracture |
|
S12.301B |
Unspecified nondisplaced fracture of fourth cervical vertebra, initial encounter for open fracture |
|
S12.400A |
Unspecified displaced fracture of fifth cervical vertebra, initial encounter for closed fracture |
|
S12.400B |
Unspecified displaced fracture of fifth cervical vertebra, initial encounter for open fracture |
|
S12.401A |
Unspecified nondisplaced fracture of fifth cervical vertebra, initial encounter for closed fracture |
|
S12.401B |
Unspecified nondisplaced fracture of fifth cervical vertebra, initial encounter for open fracture |
|
S12.500A |
Unspecified displaced fracture of sixth cervical vertebra, initial encounter for closed fracture |
|
S12.500B |
Unspecified displaced fracture of sixth cervical vertebra, initial encounter for open fracture |
|
S12.501A |
Unspecified nondisplaced fracture of sixth cervical vertebra, initial encounter for closed fracture |
|
S12.501B |
Unspecified nondisplaced fracture of sixth cervical vertebra, initial encounter for open fracture |
|
S12.600A |
Unspecified displaced fracture of seventh cervical vertebra, initial encounter for closed fracture |
|
S12.600B |
Unspecified displaced fracture of seventh cervical vertebra, initial encounter for open fracture |
|
S12.601A |
Unspecified nondisplaced fracture of seventh cervical vertebra, initial encounter for closed fracture |
|
S12.601B |
Unspecified nondisplaced fracture of seventh cervical vertebra, initial encounter for open fracture |
|
S12.9XXA |
Fracture of neck, unspecified, initial encounter |
|
S14.0XXA |
Concussion and edema of cervical spinal cord, initial encounter |
|
S14.101A |
Unspecified injury at C1 level of cervical spinal cord, initial encounter |
|
S14.102A |
Unspecified injury at C2 level of cervical spinal cord, initial encounter |
|
S14.103A |
Unspecified injury at C3 level of cervical spinal cord, initial encounter |
|
S14.104A |
Unspecified injury at C4 level of cervical spinal cord, initial encounter |
|
S14.105A |
Unspecified injury at C5 level of cervical spinal cord, initial encounter |
|
S14.106A |
Unspecified injury at C6 level of cervical spinal cord, initial encounter |
|
S14.107A |
Unspecified injury at C7 level of cervical spinal cord, initial encounter |
|
S14.108A |
Unspecified injury at C8 level of cervical spinal cord, initial encounter |
|
S14.111A |
Complete lesion at C1 level of cervical spinal cord, initial encounter |
|
S14.112A |
Complete lesion at C2 level of cervical spinal cord, initial encounter |
|
S14.113A |
Complete lesion at C3 level of cervical spinal cord, initial encounter |
|
S14.114A |
Complete lesion at C4 level of cervical spinal cord, initial encounter |
|
S14.115A |
Complete lesion at C5 level of cervical spinal cord, initial encounter |
|
S14.116A |
Complete lesion at C6 level of cervical spinal cord, initial encounter |
|
S14.117A |
Complete lesion at C7 level of cervical spinal cord, initial encounter |
|
S14.118A |
Complete lesion at C8 level of cervical spinal cord, initial encounter |
|
S14.121A |
Central cord syndrome at C1 level of cervical spinal cord, initial encounter |
|
S14.122A |
Central cord syndrome at C2 level of cervical spinal cord, initial encounter |
|
S14.123A |
Central cord syndrome at C3 level of cervical spinal cord, initial encounter |
|
S14.124A |
Central cord syndrome at C4 level of cervical spinal cord, initial encounter |
|
S14.125A |
Central cord syndrome at C5 level of cervical spinal cord, initial encounter |
|
S14.126A |
Central cord syndrome at C6 level of cervical spinal cord, initial encounter |
|
S14.127A |
Central cord syndrome at C7 level of cervical spinal cord, initial encounter |
|
S14.128A |
Central cord syndrome at C8 level of cervical spinal cord, initial encounter |
|
S14.129A |
Central cord syndrome at unspecified level of cervical spinal cord, initial encounter |
|
S14.131A |
Anterior cord syndrome at C1 level of cervical spinal cord, initial encounter |
|
S14.132A |
Anterior cord syndrome at C2 level of cervical spinal cord, initial encounter |
|
S14.133A |
Anterior cord syndrome at C3 level of cervical spinal cord, initial encounter |
|
S14.134A |
Anterior cord syndrome at C4 level of cervical spinal cord, initial encounter |
|
S14.135A |
Anterior cord syndrome at C5 level of cervical spinal cord, initial encounter |
|
S14.136A |
Anterior cord syndrome at C6 level of cervical spinal cord, initial encounter |
|
S14.137A |
Anterior cord syndrome at C7 level of cervical spinal cord, initial encounter |
|
S14.138A |
Anterior cord syndrome at C8 level of cervical spinal cord, initial encounter |
|
S14.141A |
Brown-Sequard syndrome at C1 level of cervical spinal cord, initial encounter |
|
S14.142A |
Brown-Sequard syndrome at C2 level of cervical spinal cord, initial encounter |
|
S14.143A |
Brown-Sequard syndrome at C3 level of cervical spinal cord, initial encounter |
|
S14.144A |
Brown-Sequard syndrome at C4 level of cervical spinal cord, initial encounter |
|
S14.145A |
Brown-Sequard syndrome at C5 level of cervical spinal cord, initial encounter |
|
S14.146A |
Brown-Sequard syndrome at C6 level of cervical spinal cord, initial encounter |
|
S14.147A |
Brown-Sequard syndrome at C7 level of cervical spinal cord, initial encounter |
|
S14.148A |
Brown-Sequard syndrome at C8 level of cervical spinal cord, initial encounter |
|
S14.149A |
Brown-Sequard syndrome at unspecified level of cervical spinal cord, initial encounter |
|
S14.151A |
Other incomplete lesion at C1 level of cervical spinal cord, initial encounter |
|
S14.152A |
Other incomplete lesion at C2 level of cervical spinal cord, initial encounter |
|
S14.153A |
Other incomplete lesion at C3 level of cervical spinal cord, initial encounter |
|
S14.154A |
Other incomplete lesion at C4 level of cervical spinal cord, initial encounter |
|
S14.155A |
Other incomplete lesion at C5 level of cervical spinal cord, initial encounter |
|
S14.156A |
Other incomplete lesion at C6 level of cervical spinal cord, initial encounter |
|
S14.157A |
Other incomplete lesion at C7 level of cervical spinal cord, initial encounter |
|
S14.158A |
Other incomplete lesion at C8 level of cervical spinal cord, initial encounter |
|
S14.159A |
Other incomplete lesion at unspecified level of cervical spinal cord, initial encounter |
|
S14.2XXA |
Injury of nerve root of cervical spine, initial encounter |
|
S14.4XXA |
Injury of peripheral nerves of neck, initial encounter |
|
S14.5XXA |
Injury of cervical sympathetic nerves, initial encounter |
|
S14.8XXA |
Injury of other specified nerves of neck, initial encounter |
|
S14.9XXA |
Injury of unspecified nerves of neck, initial encounter |
|
S14.3XXA |
Injury of brachial plexus, initial encounter |
|
S22.019A |
Unspecified fracture of first thoracic vertebra, initial encounter for closed fracture |
|
S22.019B |
Unspecified fracture of first thoracic vertebra, initial encounter for open fracture |
|
S22.029A |
Unspecified fracture of second thoracic vertebra, initial encounter for closed fracture |
|
S22.029B |
Unspecified fracture of second thoracic vertebra, initial encounter for open fracture |
|
S22.039A |
Unspecified fracture of third thoracic vertebra, initial encounter for closed fracture |
|
S22.039B |
Unspecified fracture of third thoracic vertebra, initial encounter for open fracture |
|
S22.049A |
Unspecified fracture of fourth thoracic vertebra, initial encounter for closed fracture |
|
S22.049B |
Unspecified fracture of fourth thoracic vertebra, initial encounter for open fracture |
|
S22.059A |
Unspecified fracture of T5-T6 vertebra, initial encounter for closed fracture |
|
S22.059B |
Unspecified fracture of T5-T6 vertebra, initial encounter for open fracture |
|
S22.069A |
Unspecified fracture of T7-T8 vertebra, initial encounter for closed fracture |
|
S22.069B |
Unspecified fracture of T7-T8 vertebra, initial encounter for open fracture |
|
S22.079A |
Unspecified fracture of T9-T10 vertebra, initial encounter for closed fracture |
|
S22.079B |
Unspecified fracture of T9-T10 vertebra, initial encounter for open fracture |
|
S22.089A |
Unspecified fracture of T11-T12 vertebra, initial encounter for closed fracture |
|
S22.089B |
Unspecified fracture of T11-T12 vertebra, initial encounter for open fracture |
|
S24.0XXA |
Concussion and edema of thoracic spinal cord, initial encounter |
|
S24.101A |
Unspecified injury at T1 level of thoracic spinal cord, initial encounter |
|
S24.102A |
Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter |
|
S24.103A |
Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter |
|
S24.104A |
Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter |
|
S24.109A |
Unspecified injury at unspecified level of thoracic spinal cord, initial encounter |
|
S24.111A |
Complete lesion at T1 level of thoracic spinal cord, initial encounter |
|
S24.112A |
Complete lesion at T2-T6 level of thoracic spinal cord, initial encounter |
|
S24.113A |
Complete lesion at T7-T10 level of thoracic spinal cord, initial encounter |
|
S24.114A |
Complete lesion at T11-T12 level of thoracic spinal cord, initial encounter |
|
S24.119A |
Complete lesion at unspecified level of thoracic spinal cord, initial encounter |
|
S24.131A |
Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter |
|
S24.132A |
Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter |
|
S24.133A |
Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter |
|
S24.134A |
Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter |
|
S24.139A |
Anterior cord syndrome at unspecified level of thoracic spinal cord, initial encounter |
|
S24.141A |
Brown-Sequard syndrome at T1 level of thoracic spinal cord, initial encounter |
|
S24.142A |
Brown-Sequard syndrome at T2-T6 level of thoracic spinal cord, initial encounter |
|
S24.143A |
Brown-Sequard syndrome at T7-T10 level of thoracic spinal cord, initial encounter |
|
S24.144A |
Brown-Sequard syndrome at T11-T12 level of thoracic spinal cord, initial encounter |
|
S24.149A |
Brown-Sequard syndrome at unspecified level of thoracic spinal cord, initial encounter |
|
S24.151A |
Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter |
|
S24.152A |
Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter |
|
S24.153A |
Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter |
|
S24.154A |
Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter |
|
S24.159A |
Other incomplete lesion at unspecified level of thoracic spinal cord, initial encounter |
|
S24.2XXA |
Injury of nerve root of thoracic spine, initial encounter |
|
S24.3XXA |
Injury of peripheral nerves of thorax, initial encounter |
|
S24.4XXA |
Injury of thoracic sympathetic nervous system, initial encounter |
|
S24.8XXA |
Injury of other specified nerves of thorax, initial encounter |
|
S24.9XXA |
Injury of unspecified nerve of thorax, initial encounter |
|
S32.019A |
Unspecified fracture of first lumbar vertebra, initial encounter for closed fracture |
|
S32.019B |
Unspecified fracture of first lumbar vertebra, initial encounter for open fracture |
|
S32.029A |
Unspecified fracture of second lumbar vertebra, initial encounter for closed fracture |
|
S32.029B |
Unspecified fracture of second lumbar vertebra, initial encounter for open fracture |
|
S32.039A |
Unspecified fracture of third lumbar vertebra, initial encounter for closed fracture |
|
S32.039B |
Unspecified fracture of third lumbar vertebra, initial encounter for open fracture |
|
S32.049A |
Unspecified fracture of fourth lumbar vertebra, initial encounter for closed fracture |
|
S32.049B |
Unspecified fracture of fourth lumbar vertebra, initial encounter for open fracture |
|
S32.059A |
Unspecified fracture of fifth lumbar vertebra, initial encounter for closed fracture |
|
S32.059B |
Unspecified fracture of fifth lumbar vertebra, initial encounter for open fracture |
|
S32.2XXA |
Fracture of coccyx, initial encounter for closed fracture |
|
S32.2XXB |
Fracture of coccyx, initial encounter for open fracture |
|
S34.01XA |
Concussion and edema of lumbar spinal cord, initial encounter |
|
S34.02XA |
Concussion and edema of sacral spinal cord, initial encounter |
|
S34.101A |
Unspecified injury to L1 level of lumbar spinal cord, initial encounter |
|
S34.102A |
Unspecified injury to L2 level of lumbar spinal cord, initial encounter |
|
S34.103A |
Unspecified injury to L3 level of lumbar spinal cord, initial encounter |
|
S34.104A |
Unspecified injury to L4 level of lumbar spinal cord, initial encounter |
|
S34.105A |
Unspecified injury to L5 level of lumbar spinal cord, initial encounter |
|
S34.111A |
Complete lesion of L1 level of lumbar spinal cord, initial encounter |
|
S34.112A |
Complete lesion of L2 level of lumbar spinal cord, initial encounter |
|
S34.113A |
Complete lesion of L3 level of lumbar spinal cord, initial encounter |
|
S34.114A |
Complete lesion of L4 level of lumbar spinal cord, initial encounter |
|
S34.115A |
Complete lesion of L5 level of lumbar spinal cord, initial encounter |
|
S34.121A |
Incomplete lesion of L1 level of lumbar spinal cord, initial encounter |
|
S34.122A |
Incomplete lesion of L2 level of lumbar spinal cord, initial encounter |
|
S34.123A |
Incomplete lesion of L3 level of lumbar spinal cord, initial encounter |
|
S34.124A |
Incomplete lesion of L4 level of lumbar spinal cord, initial encounter |
|
S34.125A |
Incomplete lesion of L5 level of lumbar spinal cord, initial encounter |
|
S34.131A |
Complete lesion of sacral spinal cord, initial encounter |
|
S34.132A |
Incomplete lesion of sacral spinal cord, initial encounter |
|
S34.139A |
Unspecified injury to sacral spinal cord, initial encounter |
|
S34.21XA |
Injury of nerve root of lumbar spine, initial encounter |
|
S34.22XA |
Injury of nerve root of sacral spine, initial encounter |
|
S34.3XXA |
Injury of cauda equina, initial encounter |
|
S34.4XXA |
Injury of lumbosacral plexus, initial encounter |
|
S34.5XXA |
Injury of lumbar, sacral and pelvic sympathetic nerves, initial encounter |
|
S34.6XXA |
Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, initial encounter |
|
S34.8XXA |
Injury of other nerves at abdomen, lower back and pelvis level, initial encounter |
|
S34.9XXA |
Injury of unspecified nerves at abdomen, lower back and pelvis level, initial encounter |
|
S44.00XA |
Injury of ulnar nerve at upper arm level, unspecified arm, initial encounter |
|
S44.01XA |
Injury of ulnar nerve at upper arm level, right arm, initial encounter |
|
S44.02XA |
Injury of ulnar nerve at upper arm level, left arm, initial encounter |
|
S44.10XA |
Injury of median nerve at upper arm level, unspecified arm, initial encounter |
|
S44.11XA |
Injury of median nerve at upper arm level, right arm, initial encounter |
|
S44.12XA |
Injury of median nerve at upper arm level, left arm, initial encounter |
|
S44.20XA |
Injury of radial nerve at upper arm level, unspecified arm, initial encounter |
|
S44.21XA |
Injury of radial nerve at upper arm level, right arm, initial encounter |
|
S44.22XA |
Injury of radial nerve at upper arm level, left arm, initial encounter |
|
S44.30XA |
Injury of axillary nerve, unspecified arm, initial encounter |
|
S44.31XA |
Injury of axillary nerve, right arm, initial encounter |
|
S44.32XA |
Injury of axillary nerve, left arm, initial encounter |
|
S44.40XA |
Injury of musculocutaneous nerve, unspecified arm, initial encounter |
|
S44.41XA |
Injury of musculocutaneous nerve, right arm, initial encounter |
|
S44.42XA |
Injury of musculocutaneous nerve, left arm, initial encounter |
|
S44.50XA |
Injury of cutaneous sensory nerve at shoulder and upper arm level, unspecified arm, initial encounter |
|
S44.51XA |
Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, initial encounter |
|
S44.52XA |
Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, initial encounter |
|
S44.8X1A |
Injury of other nerves at shoulder and upper arm level, right arm, initial encounter |
|
S44.8X2A |
Injury of other nerves at shoulder and upper arm level, left arm, initial encounter |
|
S44.8X9A |
Injury of other nerves at shoulder and upper arm level, unspecified arm, initial encounter |
|
S54.00XA |
Injury of ulnar nerve at forearm level, unspecified arm, initial encounter |
|
S54.01XA |
Injury of ulnar nerve at forearm level, right arm, initial encounter |
|
S54.02XA |
Injury of ulnar nerve at forearm level, left arm, initial encounter |
|
S54.10XA |
Injury of median nerve at forearm level, unspecified arm, initial encounter |
|
S54.11XA |
Injury of median nerve at forearm level, right arm, initial encounter |
|
S54.12XA |
Injury of median nerve at forearm level, left arm, initial encounter |
|
S54.20XA |
Injury of radial nerve at forearm level, unspecified arm, initial encounter |
|
S54.21XA |
Injury of radial nerve at forearm level, right arm, initial encounter |
|
S54.22XA |
Injury of radial nerve at forearm level, left arm, initial encounter |
|
S54.31XA |
Injury of cutaneous sensory nerve at forearm level, right arm, initial encounter |
|
S54.32XA |
Injury of cutaneous sensory nerve at forearm level, left arm, initial encounter |
|
S54.8X1A |
Injury of other nerves at forearm level, right arm, initial encounter |
|
S54.8X2A |
Injury of other nerves at forearm level, left arm, initial encounter |
|
S54.8X9A |
Injury of other nerves at forearm level, unspecified arm, initial encounter |
|
S54.90XA |
Injury of unspecified nerve at forearm level, unspecified arm, initial encounter |
|
S54.91XA |
Injury of unspecified nerve at forearm level, right arm, initial encounter |
|
S54.92XA |
Injury of unspecified nerve at forearm level, left arm, initial encounter |
|
S64.00XA |
Injury of ulnar nerve at wrist and hand level of unspecified arm, initial encounter |
|
S64.01XA |
Injury of ulnar nerve at wrist and hand level of right arm, initial encounter |
|
S64.02XA |
Injury of ulnar nerve at wrist and hand level of left arm, initial encounter |
|
S64.10XA |
Injury of median nerve at wrist and hand level of unspecified arm, initial encounter |
|
S64.11XA |
Injury of median nerve at wrist and hand level of right arm, initial encounter |
|
S64.12XA |
Injury of median nerve at wrist and hand level of left arm, initial encounter |
|
S64.20XA |
Injury of radial nerve at wrist and hand level of unspecified arm, initial encounter |
|
S64.21XA |
Injury of radial nerve at wrist and hand level of right arm, initial encounter |
|
S64.22XA |
Injury of radial nerve at wrist and hand level of left arm, initial encounter |
|
S64.30XA |
Injury of digital nerve of unspecified thumb, initial encounter |
|
S64.31XA |
Injury of digital nerve of right thumb, initial encounter |
|
S64.32XA |
Injury of digital nerve of left thumb, initial encounter |
|
S64.40XA |
Injury of digital nerve of unspecified finger, initial encounter |
|
S64.490A |
Injury of digital nerve of right index finger, initial encounter |
|
S64.491A |
Injury of digital nerve of left index finger, initial encounter |
|
S64.492A |
Injury of digital nerve of right middle finger, initial encounter |
|
S64.493A |
Injury of digital nerve of left middle finger, initial encounter |
|
S64.494A |
Injury of digital nerve of right ring finger, initial encounter |
|
S64.495A |
Injury of digital nerve of left ring finger, initial encounter |
|
S64.496A |
Injury of digital nerve of right little finger, initial encounter |
|
S64.497A |
Injury of digital nerve of left little finger, initial encounter |
|
S64.498A |
Injury of digital nerve of other finger, initial encounter |
|
S64.8X1A |
Injury of other nerves at wrist and hand level of right arm, initial encounter |
|
S64.8X2A |
Injury of other nerves at wrist and hand level of left arm, initial encounter |
|
S64.91XA |
Injury of unspecified nerve at wrist and hand level of right arm, initial encounter |
|
S64.92XA |
Injury of unspecified nerve at wrist and hand level of left arm, initial encounter |
|
S74.00XA |
Injury of sciatic nerve at hip and thigh level, unspecified leg, initial encounter |
|
S74.01XA |
Injury of sciatic nerve at hip and thigh level, right leg, initial encounter |
|
S74.02XA |
Injury of sciatic nerve at hip and thigh level, left leg, initial encounter |
|
S74.10XA |
Injury of femoral nerve at hip and thigh level, unspecified leg, initial encounter |
|
S74.11XA |
Injury of femoral nerve at hip and thigh level, right leg, initial encounter |
|
S74.12XA |
Injury of femoral nerve at hip and thigh level, left leg, initial encounter |
|
S74.20XA |
Injury of cutaneous sensory nerve at hip and thigh level, unspecified leg, initial encounter |
|
S74.21XA |
Injury of cutaneous sensory nerve at hip and thigh level, right leg, initial encounter |
|
S74.22XA |
Injury of cutaneous sensory nerve at hip and thigh level, left leg, initial encounter |
|
S74.8X1A |
Injury of other nerves at hip and thigh level, right leg, initial encounter |
|
S74.8X2A |
Injury of other nerves at hip and thigh level, left leg, initial encounter |
|
S74.8X9A |
Injury of other nerves at hip and thigh level, unspecified leg, initial encounter |
|
S74.91XA |
Injury of unspecified nerve at hip and thigh level, right leg, initial encounter |
|
S74.92XA |
Injury of unspecified nerve at hip and thigh level, left leg, initial encounter |
|
S84.00XA |
Injury of tibial nerve at lower leg level, unspecified leg, initial encounter |
|
S84.01XA |
Injury of tibial nerve at lower leg level, right leg, initial encounter |
|
S84.10XA |
Injury of peroneal nerve at lower leg level, unspecified leg, initial encounter |
|
S84.11XA |
Injury of peroneal nerve at lower leg level, right leg, initial encounter |
|
S84.12XA |
Injury of peroneal nerve at lower leg level, left leg, initial encounter |
|
S84.20XA |
Injury of cutaneous sensory nerve at lower leg level, unspecified leg, initial encounter |
|
S84.21XA |
Injury of cutaneous sensory nerve at lower leg level, right leg, initial encounter |
|
S84.22XA |
Injury of cutaneous sensory nerve at lower leg level, left leg, initial encounter |
|
S84.8X1A |
Injury of other nerves at lower leg level, right leg, initial encounter |
|
S84.8X2A |
Injury of other nerves at lower leg level, left leg, initial encounter |
|
S84.8X9A |
Injury of other nerves at lower leg level, unspecified leg, initial encounter |
|
S84.90XA |
Injury of unspecified nerve at lower leg level, unspecified leg, initial encounter |
|
S84.91XA |
Injury of unspecified nerve at lower leg level, right leg, initial encounter |
|
S84.92XA |
Injury of unspecified nerve at lower leg level, left leg, initial encounter |
|
S94.00XA |
Injury of lateral plantar nerve, unspecified leg, initial encounter |
|
S94.01XA |
Injury of lateral plantar nerve, right leg, initial encounter |
|
S94.02XA |
Injury of lateral plantar nerve, left leg, initial encounter |
|
S94.10XA |
Injury of medial plantar nerve, unspecified leg, initial encounter |
|
S94.11XA |
Injury of medial plantar nerve, right leg, initial encounter |
|
S94.12XA |
Injury of medial plantar nerve, left leg, initial encounter |
|
S94.20XA |
Injury of deep peroneal nerve at ankle and foot level, unspecified leg, initial encounter |
|
S94.21XA |
Injury of deep peroneal nerve at ankle and foot level, right leg, initial encounter |
|
S94.22XA |
Injury of deep peroneal nerve at ankle and foot level, left leg, initial encounter |
|
S94.30XA |
Injury of cutaneous sensory nerve at ankle and foot level, unspecified leg, initial encounter |
|
S94.31XA |
Injury of cutaneous sensory nerve at ankle and foot level, right leg, initial encounter |
|
S94.32XA |
Injury of cutaneous sensory nerve at ankle and foot level, left leg, initial encounter |
|
S94.8X1A |
Injury of other nerves at ankle and foot level, right leg, initial encounter |
|
S94.8X2A |
Injury of other nerves at ankle and foot level, left leg, initial encounter |
|
S94.90XA |
Injury of unspecified nerve at ankle and foot level, unspecified leg, initial encounter |
|
S94.91XA |
Injury of unspecified nerve at ankle and foot level, right leg, initial encounter |
|
S94.92XA |
Injury of unspecified nerve at ankle and foot level, left leg, initial encounter |
|
SS84.02XA |
Injury of tibial nerve at lower leg level, left leg, initial encounter |
References
- Gooch CL, Weimer LH. The electrodiagnosis of neuropathy: basic principles and common pitfalls. Neurol Clin. Feb 2007; 25(1): 1-28. PMID 17324718
- American Association of Neuromuscular & Electrodiagnostic Medicine. Recommended policy for electrodiagnostic medicine. 2023.
- Lee DH, Claussen GC, Oh S. Clinical nerve conduction and needle electromyography studies. J Am Acad Orthop Surg. 2004; 12(4): 276-87. PMID 15473679
- American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. February 29, 2016;
- Fowler JR, Munsch M, Tosti R, et al. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. J Bone Joint Surg Am. Sep 03 2014; 96(17): e148. PMID 25187592
- Chang MH, Liu LH, Lee YC, et al. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electrodiagnosis of carpal tunnel syndrome. Clin Neurophysiol. May 2006; 117(5): 984-91. PMID 16551510
- Homan MM, Franzblau A, Werner RA, et al. Agreement between symptom surveys, physical examination procedures and electrodiagnostic findings for the carpal tunnel syndrome. Scand J Work Environ Health. Apr 1999; 25(2): 115-24. PMID 10360466
- 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. Aug 2017; 5(8): e1440. PMID 28894661
- North American Spine Society (NASS) Evidence-Based Clinical Guidelines Committee. Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care. 2012;
- Mondelli M, Aretini A, Arrigucci U, et al. Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc. Neurophysiol Clin. Oct 2013; 43(4): 205-15. PMID 24094906
- Marciniak C, Armon C, Wilson J, et al. Practice parameter: utility of electrodiagnostic techniques in evaluating patients with suspected peroneal neuropathy: an evidence-based review. Muscle Nerve. Apr 2005; 31(4): 520-7. PMID 15768387
- Rabie M, Jossiphov J, Nevo Y. Electromyography (EMG) accuracy compared to muscle biopsy in childhood. J Child Neurol. Jul 2007; 22(7): 803-8. PMID 17715269
- Ghosh PS, Sorenson EJ. Diagnostic yield of electromyography in children with myopathic disorders. Pediatr Neurol. Aug 2014; 51(2): 215-9. PMID 24950662
- American Academy of Neurology (AAN). Position Statement: diagnostic electromyography in the practice of medicine. 2004;
- American Association of Neuromuscular & Electrodiagnostic Medicine. Model Policy for Needle Electromyography and Nerve Conduction Studies. 2022;
- Olney RK, Lewis RA, Putnam TD, et al. Consensus criteria for the diagnosis of multifocal motor neuropathy. Muscle Nerve. Jan 2003; 27(1): 117-21. PMID 12508306
- AANEM policy statement on electrodiagnosis for distal symmetric polyneuropathy. Muscle Nerve. Feb 2018; 57(2): 337-339. PMID 29178499
- Kang PB, McMillan HJ, Kuntz NL, et al. Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement. Muscle Nerve. Feb 2020; 61(2): 143-155. PMID 31724199
- Centers for Medicare & Medicaid Services. National Coverage Determination (NCD) for Sensory Nerve Conduction Threshold Tests (sNCTs) (160.23). 2004;
- MacDermid JC, Doherty T. Clinical and electrodiagnostic testing of carpal tunnel syndrome: a narrative review. J Orthop Sports Phys Ther. Oct 2004; 34(10): 565-88. PMID 15552704
- Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. Apr 2005; 28(4): 956-62. PMID 15793206
- Kong X, Lesser EA, Gozani SN. Repeatability of nerve conduction measurements derived entirely by computer methods. Biomed Eng Online. Nov 06 2009; 8: 33. PMID 19895683
- American Academy of Neurology (AAN). Policy & Guidelines: Endorsed or Affirmed Guidelines. n.d.;
- Dillingham T, Chen S, Andary M, et al. Establishing high-quality reference values for nerve conduction studies: A report from the normative data task force of the American Association Of Neuromuscular Electrodiagnostic Medicine. Muscle Nerve. Sep 2016; 54(3): 366-70. PMID 27238858
- Chen S, Andary M, Buschbacher R, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve. Sep 2016; 54(3): 371-7. PMID 27238640
- Leffler CT, Gozani SN, Cros D. Median neuropathy at the wrist: diagnostic utility of clinical findings and an automated electrodiagnostic device. J Occup Environ Med. Apr 2000; 42(4): 398-409. PMID 10774509
- Rotman MB, Enkvetchakul BV, Megerian JT, et al. Time course and predictors of median nerve conduction after carpal tunnel release. J Hand Surg Am. May 2004; 29(3): 367-72. PMID 15140473
- Katz RT. NC-stat as a screening tool for carpal tunnel syndrome in industrial workers. J Occup Environ Med. Apr 2006; 48(4): 414-8. PMID 16607197
- Armstrong TN, Dale AM, Al-Lozi MT, et al. Median and ulnar nerve conduction studies at the wrist: criterion validity of the NC-stat automated device. J Occup Environ Med. Jul 2008; 50(7): 758-64. PMID 18617831
- Bourke HE, Read J, Kampa R, et al. Clinic-based nerve conduction studies reduce time to surgery and are cost effective: a comparison with formal electrophysiological testing. Ann R Coll Surg Engl. Apr 2011; 93(3): 236-40. PMID 21477439
- Megerian JT, Kong X, Gozani SN. Utility of nerve conduction for carpal tunnel syndrome by family medicine, primary care, and internal medicine physicians. J Am Board Fam Med. Jan-Feb 2007; 20(1): 60-4. PMID 17204736
- Fisher MA, Bajwa R, Somashekar KN. Routine electrodiagnosis and a multiparameter technique in lumbosacral radiculopathies. Acta Neurol Scand. Aug 2008; 118(2): 99-105. PMID 18355396
- Schmidt K, Chinea NM, Sorenson EJ, et al. Accuracy of diagnoses delivered by an automated hand-held nerve conduction device in comparison to standard electrodiagnostic testing in patients with unilateral leg symptoms. Muscle Nerve. Jan 2011; 43(1): 9-13. PMID 21108323
- England JD, Franklin GM. Automated hand-held nerve conduction devices: raw data, raw interpretations. Muscle Nerve. Jun 2011; 43(1): 6-8. PMID 21171092
- Perkins BA, Grewal J, Ng E, et al. Validation of a novel point-of-care nerve conduction device for the detection of diabetic sensorimotor polyneuropathy. Diabetes Care. Sep 2006; 29(9): 2023-7. PMID 16936147
- Sharma S, Vas PR, Rayman G. Assessment of diabetic neuropathy using a point-of-care nerve conduction device shows significant associations with the LDIFLARE method and clinical neuropathy scoring. J Diabetes Sci Technol. Jan 2015; 9(1): 123-31. PMID 25231114
- Chatzikosma D, Patili K, Demetriou M, et al. Evaluation of sural nerve automated nerve conduction study in the diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus. Arch Med Sci. Apr 01 2016; 12(2): 390-3. PMID 27186185
- Young MJ, Boulton AJ, MacLeod AF, et al. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. Feb 1993; 36(2): 150-4. PMID 8458529
- American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Proper Performance and Interpretation of Electrodiagnostic Studies. 2025
Other Sources:
- Mosby's Medical, Nursing and Allied Health Dictionary, 6th edition.
Policy history |
|
|
MP 2.063 |
02/20/2020 Consensus Review. Policy statement unchanged. References updated. |
|
09/02/2020 Administrative Update. ICD codes added, G71.20, G71.21, G71.22, G71.220, G71.228, G71.29 |
|
|
01/14/2021 Consensus Review. Background updated. Coding reviewed and references updated. |
|
|
07/19/2022 Consensus Review. No change to policy statement. References reviewed and updated. FEP language updated. |
|
|
12/18/2023 Consensus Review. No change to policy statement. Policy guidelines, background, and cross-references updated. Coding reviewed, no changes. |
|
|
08/27/2024 Minor Review. Added automated nerve conduction tests as INV with codes 95905, 95999, and G0255. Updated background, rationale, references. |
|
|
05/15/2025 Consensus Review. No change to policy statement. Coding reviewed, no changes. |
|
|
07/18/2025 Administrative Update. Removed Benefit Variations Section and updated Disclaimer. |
|
|
09/02/2025 Administrative Update. Added ICD10 code G71.036 as part of the new code update for 10/02/2025 |
|
|
05/14/2026 Consensus Review. Editorial updates to policy statements by changing ‘patient’ to ‘individual’, no change to intent. Updated policy guidelines, background, definition, rationale, and references. Coding reviewed, updated ICD-10 coding table. |
|