CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB064

Nerve Fiber Density Testing (skin biopsy for epidermal nerve fiber density)

Defines BCBSNM lab management reimbursement criteria for skin biopsy with epidermal nerve fiber density measurement for diagnosis of small-fiber (painful sensory) neuropathy, exclusions for other uses, and lists related procedure codes. Applies to Plan products where benefit allows.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyNerve Fiber Density Testing (skin biopsy for epidermal nerve fiber density)

Policy CodePolicy CPCPLAB064

Change TypeRevised (literature review; reimbursement language clarified) — 7/5/2023

Effective DateSep 1, 2023

Next Review DateN/A

Key ActionDocument presence of painful sensory neuropathy symptoms, absence of disorders that predispose to painful neuropathy, exam excluding large-fiber neuropathy, and normal EMG/nerve-conduction studies to support reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes — policy updated with literature review and clarifying reimbursement information; no additional information added (7/5/2023).

1Covered Indication (diagnostic use)

1Explicit Not Reimbursable Use (sweat gland NFD)

8Procedure Codes Listed

Policy summary

BCBSNM has implemented laboratory management reimbursement criteria for skin biopsy with epidermal nerve fiber density measurement to assist in the diagnosis of painful small-fiber (sensory) neuropathy. The policy defines specific clinical criteria that must all be met for reimbursement (symptoms of painful sensory neuropathy; no history of disorders known to predispose to painful neuropathy; physical exam without findings of large-fiber neuropathy; and normal electromyography/nerve-conduction studies).

Not all requirements apply to every product — plan documents govern coverage applicability and will control in the event of any conflict. Providers should follow plan documents and submission requirements when seeking reimbursement.

The policy references current literature and specialty-society practice parameters and guidance as sources informing these reimbursement criteria.

Policy metadata

Policy NumberCPCPLAB064

SubjectNerve Fiber Density Testing (skin biopsy for epidermal nerve fiber density)

Enterprise Approval Date2023-07-05

Plan Effective Date2023-09-01

Effective Date2023-09-01

Last Review Date2023-07-05

StatusCURRENT

Scope SummaryDefines BCBSNM lab management reimbursement criteria for skin biopsy with epidermal nerve fiber density measurement for diagnosis of small-fiber (painful sensory) neuropathy, exclusions for other uses, and lists related procedure codes. Applies to Plan products where benefit allows.

Coverage criteria and exclusions

Reimbursable Indication - Diagnosis of Small-Fiber Neuropathy

Reimbursable when ALL of the following are met:

ALL of the following

An individual presents with symptoms of painful sensory neuropathy
There is no history of a disorder known to predispose to painful neuropathy (examples: diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy)
Physical examination shows no evidence of findings consistent with large-fiber neuropathy (examples: reduced or absent muscle-stretch reflexes or reduced proprioception and vibration sensation)
Electromyography and nerve-conduction studies are normal and show no evidence of large-fiber neuropathy

Not Reimbursable

Not reimbursable for the following situations:

ANY of the following

For all other conditions, including but not limited to monitoring of disease progression or response to treatment
Measurement of sweat gland nerve fiber density

Key dates and thresholds

Plan Effective Date2023-09-01

Last Review Date2023-07-05

Billing, documentation, and coding guidance

Documentation Required

Document clinical criteria for small-fiber neuropathy diagnosis

Providers must document: presence of painful sensory neuropathy symptoms; absence of a history of disorders known to predispose to painful neuropathy (examples: diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy); physical exam findings that exclude large-fiber neuropathy (for example, no reduced or absent muscle-stretch reflexes and no reduced proprioception or vibration sensation); and normal electromyography and nerve‑conduction study results showing no evidence of large‑fiber neuropathy to support reimbursement for skin biopsy with epidermal nerve fiber density measurement.

88305
88314
88341
88342
88344
88346
88350
88356

Billing Rule

Code submission requirements and coding guidance

Submit claims using valid HIPAA‑approved code combinations and appropriate industry-standard code sets. Claims are subject to code edit protocols and claim review and may require review against plan documents, provider contract language, medical policies, and CPCPs. Upon request, providers may be asked to submit additional documentation to support the claim.

Plan documents, provider contract language, medical policies, and CPCPs may be referenced during claim review.
Providers may be requested to submit additional documentation upon request.

Background and evidence references

The policy includes literature references and guidance that align with specialty society practice parameters and relevant clinical guidance for the evaluation of small-fiber neuropathy; literature citations and guideline sources are provided in the policy reference list.

Not all listed requirements apply to each product; plan documents govern coverage applicability. The policy was updated with a literature review on 7/5/2023 and the document history notes the initial publication on 11/1/2022.

Evidence

Enterprise Approval Date2023-07-05

Plan Effective Date2023-09-01

Policy changes

11/1/2022added

New policy (initial publication).

7/5/2023revisedLatest

Document updated with literature review; reimbursement information revised for clarity; references revised; no additional information added.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyNerve Fiber Density Testing (skin biopsy for epidermal nerve fiber density)

Policy CodePolicy CPCPLAB064

Change TypeRevised (literature review; reimbursement language clarified) — 7/5/2023

Effective DateSep 1, 2023

Next Review DateN/A

SourceLink

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OpenPayer

Nerve Fiber Density Testing (skin biopsy for epidermal nerve fiber density)

Policy summary

Coverage criteria and exclusions

Procedure codes

Billing, documentation, and coding guidance

Key terms

Background and evidence references

Policy changes

88305
88314
88341
88342
88344
88346
88350
88356