CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLABO64

Nerve Fiber Density Testing

This policy governs reimbursement criteria for epidermal nerve fiber density measurement (skin biopsy) for diagnosis of small-fiber neuropathy for Blue Cross Blue Shield of Oklahoma members and providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyNerve Fiber Density Testing

Policy CodePolicy CPCPLABO64

Change TypeClarifiedRevisedAdded

Effective DateJan 15, 2025

Next Review Date

Key ActionProviders must submit accurate documentation for services and may be asked to provide additional records during claim review.

SourceLink

POLICY UPDATE CHANGES

Document updated with literature review; Reimbursement Information unchanged; References revised.

Reimbursement Information revised for clarity and code list updated: added code 88313; removed codes 88305 and 88314.

New policy established on 11/01/2022.

6procedure codes listed

ALLcriteria required for reimbursement

SGNFDexplicitly not reimbursable

3update history entries

Reimbursement Criteria

Reimbursement criteria for ENFD testing

For diagnosis of small-fiber neuropathy, epidermal nerve fiber density measurement from a skin biopsy may be reimbursable when ALL of the following are met:

ALL of the following

Individual presents with symptoms of painful sensory neuropathy
No history of a disorder known to predispose to painful neuropathy (examples include diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy)
Physical examination shows no evidence of large-fiber neuropathy (eg, no reduced or absent muscle-stretch reflexes; no reduced proprioception or vibration sensation)
Electromyography and nerve-conduction studies are normal and show no evidence of large-fiber neuropathy

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyNerve Fiber Density Testing

Policy CodePolicy CPCPLABO64

Change TypeClarifiedRevisedAdded

Effective DateJan 15, 2025

Next Review Date

Key ActionProviders must submit accurate documentation for services and may be asked to provide additional records during claim review.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Applicable Codes and Coding Rules

Listed pathology/histology codesCPTCovered

88313
88341
88342
88344
88346
88350
88356

Notesmixed

N/A	The following is not an all-encompassing code list: The inclusion of a code does not guarantee it is a covered service or eligible for reimbursement.

Reimbursement condition requirement

Reimbursement requirementEpidermal nerve fiber density measurement from a skin biopsy may be reimbursable only when ALL listed clinical conditions are met: symptoms of painful sensory neuropathy; no history of disorders known to predispose to painful neuropathy; physical exam shows no evidence of large-fiber neuropathy; electromyography and nerve-conduction studies normal with no evidence of large-fiber neuropathy.

ScopeApplies to diagnosis of small-fiber neuropathy only; other situations are not reimbursable.

ExclusionsMeasurement of sweat gland nerve fiber density is not reimbursable.

Documentation & Claim Submission

Documentation Required

Documentation and claim submission responsibilities

Providers are responsible for submission of accurate documentation of services performed and must submit claims using valid code combinations from HIPAA-approved code sets. Claims are subject to review against benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding edit protocols; upon request, the provider is urged to submit any additional documentation to support the claim.

Submit claims coded per industry standard coding guidelines (eg, CPT, HCPCS, ICD-10-CM/PCS, NDC, DRG) and applicable coding authorities.
Be prepared to provide additional records or documentation upon request for claim review and adjudication.
Claims may be reviewed against plan documents and provider contracts; plan documents govern coverage conflicts.

Key Definitions

ENFD (epidermal nerve fiber density) testing

DefinitionEpidermal nerve fiber density (ENFD) testing is the measurement of epidermal nerve fiber density from a skin biopsy used in evaluation for small-fiber neuropathy.

IndicationMay be reimbursable when performed to diagnose small-fiber neuropathy and all clinical criteria in the policy are met.

Relation to other testsRequired complementary findings: normal electromyography and nerve-conduction studies demonstrating no large-fiber neuropathy.

SGNFD (sweat gland nerve fiber density)

Policy statementMeasurement of sweat gland nerve fiber density (SGNFD) is explicitly not reimbursable under this policy.

ContextSGNFD is listed as an exclusion separate from ENFD testing; claims for SGNFD should not be reimbursed.

Implication for coding/claimsDo not submit or expect reimbursement for procedures described as measurement of sweat gland nerve fiber density under this policy.