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Defines Blue Cross Blue Shield Rhode Island coverage position for paraspinal surface electromyography (SEMG) used to evaluate and monitor back pain for Medicare Advantage and commercial products, including rationale and coding guidance.
Policy states paraspinal SEMG is not covered for Medicare Advantage and not medically necessary for Commercial products due to insufficient evidence of net health outcome improvement.
Scope: Defines Blue Cross Blue Shield Rhode Island coverage position for paraspinal surface electromyography (SEMG) used to evaluate and monitor back pain for Medicare Advantage and Commercial products. Subject: Paraspinal Surface Electromyography (SEMG) for Back Pain. Effective: 2016-10-01. Last review: 2024-07-17.
Coverage Determination
Policy statements for Medicare Advantage Plans and Commercial Products:
ALL of the following
Refer to member-specific benefits
Verify benefits and eligibility with the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement because coverage varies by group/contract.
Claims for paraspinal SEMG may be denied/not covered
Claims for paraspinal surface EMG (HCPCS S3900) are considered not covered for Medicare Advantage members and not medically necessary for Commercial members and may be denied accordingly.
| S3900 | Surface electromyography (EMG). |
| S3900 | Surface electromyography (EMG). |
Paraspinal SEMG is a noninvasive technique that records the summation of paraspinal muscle electrical activity using electrodes placed on the skin; recordings can be made at rest, in positions, or after exercises and analyzed by spectral analysis, amplitude, or root mean square measures.
It has been proposed for multiple clinical applications including clarification of diagnosis (muscle, joint, or disc), selection of medical or physical therapy, preoperative evaluation, postoperative rehabilitation, monitoring response to therapy, and assessing work or lifting capacity.
Evidence is limited primarily to nonrandomized studies; no studies have demonstrated effects on health outcomes or shown impact on management, and standard criteria for normal versus abnormal SEMG measurements have not been established, so the evidence is considered insufficient to determine an improvement in net health outcome.
Policy effective date
Policy last reviewed
Policy states paraspinal SEMG is not covered for Medicare Advantage and not medically necessary for Commercial products due to insufficient evidence of net health outcome improvement.
HCPCS S3900 (Surface electromyography) is specific to a surface EMG and is not covered for Medicare Advantage plans.
HCPCS S3900 (Surface electromyography) is specific to a surface EMG and is not medically necessary for Commercial products.