CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABO64

Nerve Fiber Density Testing Policy

Defines Blue Cross Blue Shield of New Mexico reimbursement criteria for skin biopsy with epidermal nerve fiber density measurement for diagnosis of small-fiber neuropathy, and exclusions such as sweat gland nerve fiber density and monitoring uses. Applies to BCBSNM plans subject to plan documents and provider contracts.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyNerve Fiber Density Testing Policy

Policy CodePolicy CPCPLABO64

Change TypeNew policy (version 1.0)

Effective DateJan 1, 2023

Next Review DateN/A

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

SourceLink

POLICY UPDATE CHANGES

New policy effective 1/1/2023 (Plan CMO Approval Date: July 27, 2022).

1Reimbursable test described

2Explicit non-reimbursable items

Policy summary & scope

This Blue Cross Blue Shield of New Mexico (BCBSNM) reimbursement policy (Policy Number CPCPLABO64, effective date 2023-01-01) defines criteria for coverage of skin biopsy with epidermal nerve fiber density measurement to aid diagnosis of small‑fiber (painful sensory) neuropathy. Reimbursement is covered_with_criteria when the specified clinical conditions are met (see policy criteria), and the policy applies to BCBSNM plans subject to applicable plan documents and provider contracts (plan documents govern coverage). Payer: Blue Cross Blue Shield - New Mexico.

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Reimbursable and non-reimbursable criteria

Reimbursable Indication (Skin biopsy with epidermal nerve fiber density measurement)

Reimbursable when ALL of these conditions are met:

ALL of the following

Individual presents with symptoms of painful sensory neuropathy
There is no history of a disorder known to predispose to painful neuropathy (e.g-, diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy)
Physical examination shows no evidence of findings consistent with large-fiber neuropathy, such as 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 other conditions or purposes:

ANY of the following

All other conditions not meeting the reimbursable criteria (including, but not limited to, the monitoring of disease progression or response to treatment)
Measurement of sweat gland nerve fiber density

Required documentation and billing implications

Documentation Required

Document clinical criteria for reimbursement

Document that the patient has symptoms of painful sensory neuropathy; that there is no history of a disorder known to predispose to painful neuropathy (for example diabetic, toxic, HIV, celiac, or inherited neuropathy); that the physical exam shows no evidence of large‑fiber neuropathy (eg, reduced/absent muscle‑stretch reflexes or reduced proprioception and vibration); and that electromyography and nerve‑conduction studies are normal and show no evidence of large‑fiber neuropathy.

Symptoms of painful sensory neuropathy
No history of a disorder known to predispose to painful neuropathy (eg diabetic, toxic, HIV, celiac, inherited)
Physical exam excluding large‑fiber neuropathy (eg reduced/absent reflexes, reduced proprioception/vibration)
Normal electromyography and nerve‑conduction studies with no evidence of large‑fiber neuropathy

Billing Rule

Use appropriate HIPAA-approved codes

Submit claims using valid code combinations from HIPAA‑approved code sets (for example CPT, HCPCS, ICD‑10) and comply with industry coding guidelines, code‑edit protocols, and claim‑edit processes.

Denial Risk

Denial risk for monitoring or sweat gland testing

Claims for skin biopsy with epidermal nerve fiber density measurement when used to monitor disease progression or response to treatment, and claims for measurement of sweat gland nerve fiber density, are not reimbursable and may be denied.