CurrentUnitedHealthcarePolicy CS082KS.02

Neurophysiologic Testing and Monitoring (for Kansas Only)

UnitedHealthcare Community Plan medical policy CS082KS.02 governing neurophysiologic/electrodiagnostic testing and monitoring for members in Kansas (adults 18+), defining medically necessary vs not medically necessary tests, applicable CPT/HCPCS codes, performance/supervision expectations, and evidence summary for select modalities.

Policy Summary

PayerUnitedHealthcare

PolicyNeurophysiologic Testing and Monitoring (for Kansas Only)

Policy CodePolicy CS082KS.02

Change TypeAdded medical necessity clarifications; designated several modalities unproven; removed codes

Effective DateApr 1, 2026

Next Review Date

Key ActionRefer to InterQual EMG/NCS criteria and ensure documentation supports the listed indications when submitting for medical necessity.

POLICY UPDATE CHANGES

Added language indicating nerve conduction studies with or without standard late responses and for neuromuscular junction testing when performed with needle EMG are proven and medically necessary for peripheral neuropathy/polyneuropathy, plexopathy, neuromuscular junction disorders, and myopathy for members under 18.

Added language indicating NCS with or without standard late responses when performed without needle EMG are proven and medically necessary for individuals with listed disorders if they are treated with anticoagulants, have lymphedema, or are being evaluated for carpal tunnel syndrome.

Designated multiple tests and device-based monitoring (macro-EMG, wearable physiologic seizure/movement monitoring, SEMG, sMMG, QST, VEP for glaucoma, SEMG-based seizure monitoring) as unproven and not medically necessary.

Removed CPT/HCPCS codes 95999 and A9279 from the Applicable Codes section.

Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect current information.

9Technologies listed as unproven/not medically necessary

Coverage Summary

This UnitedHealthcare Community Plan medical policy (Policy Number CS082KS.02, effective April 1, 2026) governs neurophysiologic and electrodiagnostic testing and monitoring for members in Kansas. The policy addresses modalities including EMG (needle and surface), nerve conduction studies (NCS) with or without standard late responses, neuromuscular junction testing, physiologic wearable monitoring, quantitative sensory testing (QST), and visual evoked potentials (VEP), and defines which indications are considered proven/medically necessary versus unproven/not medically necessary for adults aged 18 and over. A pediatric-specific provision clarifies proven/medically necessary use of NCS/EMG combinations for listed disorders in members under 18. For the detailed medical necessity criteria, refer to the InterQual CP: Procedures, Electromyography (EMG), and Nerve Conduction Studies (NCS).

Key numeric indicators

Medically necessary indications listed7

Technologies unproven/not medically necessary9

Procedure codes listed (approx.)50+

Removed CPT/HCPCS codes2

Tonic-clonic seizure detection sensitivity0.91 (mean; Naganur et al. 2022)

Wearable devices false alarm rate2.1 per 24 h (mean overall; Naganur et al. 2022)

Medical-Necessity Criteria (Adults 18+)

Medically Necessary Neurophysiologic Testing (Adults 18+)

Covered when ALL of the following are met:

ALL of the following

ONE of
- Peripheral neuropathy/polyneuropathy (e.g., inherited, metabolic, traumatic, entrapment syndromes).
- Plexopathy.
- Neuromuscular junction disorders (e.g., myasthenia gravis).
- Myopathy.

Medical-Necessity Criteria (Members Under 18)

Not Medically Necessary / Experimental

Rationale: the policy reflects that evidence of clinical benefit differs by modality and indication; in many cases evidence is insufficient to establish clinical efficacy. Where evidence supports use, specific clinical indications are listed as proven and medically necessary. Evidence summaries and detailed syntheses are presented in the Evidence section of the policy.

Background, Evidence and Guideline Guidance

Guidelines and major society statements: the AANEM and AAN provide practice recommendations endorsing properly performed NCS with complementary needle EMG and set standards for performance and supervision (physician with EDX training; technologists under direct supervision where allowed). The ILAE-IFCN conditionally recommends use of clinically validated wearable devices for automated detection of GTCS and FBTCS when safety concerns exist. AAN guidance (reaffirmed Feb 2025) notes that QST is probably effective for documenting sensory abnormalities in diabetic neuropathy (Level B) but should not be used as the sole diagnostic method. Systematic reviews and evidence syntheses show variable quality across modalities: NCS/EMG are supported for specific neuropathic, neuromuscular junction, myopathic, radiculopathic, and guidance indications; QST, point-of-care NCS devices, SEMG/sMMG, and wearable physiologic seizure monitoring have weaker, inconsistent, or limited evidence.

Evidence synthesis highlights: wearable surface EMG (sEMG) devices can detect generalized tonic-clonic seizures but have variable performance and false alarm rates. For example, Halford et al. (2017) detected 29/29 GTCS when the device was placed over the midline biceps (detection delay mean 7.70 seconds, mean FAR 1.44/24 h, PPV 6.2%); overall detection in that trial was 76% with higher FARs. Systematic reviews (Naganur et al. 2022) report mean sensitivity for tonic-clonic seizure detection of 0.91 (95% CI 0.85-0.96) with an overall FAR of 2.1/24 h. Evidence for sEMG in other clinical uses (respiratory monitoring during mechanical ventilation, ALS monitoring, trunk muscle activity in SCI, temporomandibular disorder diagnosis) is limited and insufficient to establish clinical utility.

Definitions

Term	Definition
{"text":"NCS","status":""},{"text":"Nerve conduction studies assessing speed (conduction velocity, latency), amplitude, and shape of responses; often performed with EMG.","status":""}
{"text":"EMG","status":""},{"text":"Electromyography measuring muscle response to electrical/nerve stimulation; includes needle EMG (NEMG) and surface EMG (SEMG).","status":""}
{"text":"QST","status":""},{"text":"Quantitative Sensory Testing — non-invasive assessment of peripheral sensory nerve function using stimuli (touch, vibration, temperature).","status":""}
{"text":"GTCS","status":""},{"text":"Generalized tonic-clonic seizure","status":""}
{"text":"FBTCS","status":""},{"text":"Focal to bilateral tonic-clonic seizure","status":""}
{"text":"FAR","status":""},{"text":"False alarm rate (per 24 hours)","status":""}
{"text":"QST (alt)","status":""},{"text":"Quantitative Sensory Testing","status":""}
{"text":"sEMG","status":""},{"text":"Surface electromyography","status":""}
{"text":"sEMG (expanded)","status":""},{"text":"Surface electromyography — noninvasive recording of muscle electrical activity via surface electrodes.","status":""}
{"text":"sMMG","status":""},{"text":"Surface mechanomyography — surface measurement of muscle mechanical activity, sometimes with IMU sensors.","status":""}
{"text":"icVEP","status":""},{"text":"Isolated-check visual evoked potential — an electrophysiologic test assessing visual pathway function, reported using signal-to-noise ratio (SNR).","status":""}

Coding

Listed Procedure Codes (reference only)CPT|HCPCS|mixed

0106T	Quantitative sensory testing (QST), testing and interpretation per extremity; using touch pressure stimuli to assess large diameter sensation.
0107T	Quantitative sensory testing (QST), testing and interpretation per extremity; using vibration stimuli to assess large diameter fiber sensation.
0108T	Quantitative sensory testing (QST), testing and interpretation per extremity; using cooling stimuli to assess small nerve fiber sensation and hyperalgesia.
0109T	Quantitative sensory testing (QST), testing and interpretation per extremity; using heat-pain stimuli to assess small nerve fiber sensation and hyperalgesia.
0110T	Quantitative sensory testing (QST), testing and interpretation per extremity; using other stimuli to assess sensation.
0464T	Visual evoked potential, testing for glaucoma, with interpretation and report.
0778T	Surface mechanomyography (sMMG) with concurrent application of inertial measurement unit (IMU) sensors for measurement of multi-joint range of motion, posture, gait, and muscle function.
95860	Needle electromyography; 1 extremity with or without related paraspinal areas.
95861	Needle electromyography; 2 extremities with or without related paraspinal areas.
95863	Needle electromyography; 3 extremities with or without related paraspinal areas.

1–10 of 37

1/4

Removed/Deleted CPT/HCPCS codes in policy updatemixedNot Covered

95999	Unlisted neurological procedure (removed from Applicable Codes list)
A9279	Unlisted procedure, healthcare (removed from Applicable Codes list)

Provider reminder: the CPT/HCPCS procedure code list in this policy is provided for reference only and does not guarantee coverage or reimbursement; inclusion in the policy does not imply coverage. Benefit determination is governed by federal, state, or contractual requirements and UnitedHealthcare rules.

Provider Actions & Billing Guidance

Documentation Required

Use InterQual criteria for medical necessity

Refer to InterQual® clinical criteria (CP: Procedures, Electromyography (EMG), and Nerve Conduction Studies (NCS)) for medical necessity determinations. Ensure the medical record documents the clinical presentation, diagnostic question, and findings that meet the InterQual indications referenced for NCS and/or EMG to support coverage.

Documentation Required

Performance and supervision expectations

Needle electromyography (NEMG) and nerve conduction studies (NCS) should be performed by qualified clinicians per professional society guidance. Per AANEM practice parameters, NCS may be performed by trained technologists or clinicians under appropriate supervision; needle EMG must be performed by clinicians credentialed and competent in needle EMG technique. Supervision, interpretation, and final report by the ordering/performing physician or qualified practitioner is expected.

Evidence Summary

Evidence Source	Key Finding/Value
{"text":"AANEM guidance","status":""},{"text":"Multiple AANEM position statements and model policies cited (2014 updated 2023; 1999 reapproved 2017; 2020 consensus; 2017/2024 DPN guidance).","status":""}
{"text":"Systematic reviews","status":""},{"text":"Wearable seizure/motion device reviews (Sasseville 2024; Seth 2024; Zhang 2024; Casanovas Ortega 2022) show weak/limited evidence for physiologic recording devices.","status":""}
{"text":"Macro-EMG evidence","status":""},{"text":"Limited small studies; unclear impact on patient management (Sartucci 2011).","status":""}
{"text":"EDA incidence","status":""},{"text":"Pooled electrodermal activity response incidence 82 per 100 seizures (95% CI 70-91).","status":""}
{"text":"Halford 2017 sEMG detection","status":""},{"text":"When device placed over midline biceps detected 29/29 GTCS (100%), FAR 1.44/24h, PPV 6.2%; overall detection 76% with mean FAR 2.52/24h.","status":""}
{"text":"Naganur 2022 sensitivity","status":""},{"text":"Mean sensitivity for tonic-clonic seizures 0.91 (95% CI 0.85-0.96); overall FAR 2.1/24h.","status":""}
{"text":"Monofilament meta-analysis","status":""},{"text":"Pooled sensitivity 0.53 and specificity 0.88 for monofilament testing detecting diabetic peripheral neuropathy (Wang et al. 2017).","status":""}
{"text":"icVEP pooled performance","status":""},{"text":"icVEP meta-analysis: Sensitivity 77%, Specificity 93%; authors note heterogeneity and limited high-quality trials.","status":""}
{"text":"sEMG for TMD","status":""},{"text":"sEMG for myogenous TMD: sensitivity 71.3%-80%, specificity 60.5%-76.6%; moderate accuracy at rest; limited diagnostic performance overall.","status":""}
{"text":"AANEM practice topic","status":""},{"text":"Data insufficient to determine clinical utility of sEMG for distinguishing neuropathic vs myopathic conditions (level U); two class III studies suggest sEMG may detect neuromuscular disease (level C).","status":""}

Numeric thresholds / performance

sEMG detection delay (Halford et al. 2017)mean 7.70 seconds

Naganur et al. 2022 sensitivity for tonic-clonic seizuresmean 0.91 (95% CI 0.85-0.96)

Naganur et al. 2022 overall false alarm rate2.1 per 24 hours (95% CI 1.7-2.6)

Monofilament pooled sensitivity (diabetic neuropathy)0.53

Monofilament pooled specificity (diabetic neuropathy)0.88

Revision History

2026-04-01effective_dateLatest

Policy effective date (2026-04-01) — policy becomes effective for Kansas members as of April 1, 2026.

2026-04-01material_change_addedLatest

Specifies that these NCS/EMG combinations are proven and medically necessary for listed disorders. (material): Added language indicating nerve conduction studies with or without standard late responses and for neuromuscular junction testing when performed with needle EMG are proven and medically necessary for peripheral neuropathy/polyneuropathy, plexopathy, neuromuscular junction disorders, and myopathy for members under 18. Details: Added language to indicate NCS with or without standard late responses (e.g., F-wave and H-reflex tests) and neuromuscular junction testing when performed in conjunction with needle EMG are proven and medically necessary for peripheral neuropathy/polyneuropathy, plexopathy, neuromuscular junction disorders (e.g., myasthenia gravis), myopathy, motor neuron disease, radiculopathy, and for treatment guidance such as muscle localization for botulinum toxin injections.

Policy Summary

PayerUnitedHealthcare

PolicyNeurophysiologic Testing and Monitoring (for Kansas Only)

Policy CodePolicy CS082KS.02

Change TypeAdded medical necessity clarifications; designated several modalities unproven; removed codes

Effective DateApr 1, 2026

Next Review Date

Key ActionRefer to InterQual EMG/NCS criteria and ensure documentation supports the listed indications when submitting for medical necessity.

On This Page

AANEM statements and related considerations

Quantitative sensory testing (QST) and small nerve conduction testing (sNCT): Per AANEM statements, QST and sNCT have limited diagnostic utility and are not standalone replacements for standard electrodiagnostic studies; their use should be considered adjunctive and interpreted in the context of clinical examination and other electrodiagnostic testing.
Surface EMG (sEMG): sEMG is not a substitute for needle EMG for diagnostic evaluation of neuromuscular disorders. Use of sEMG for seizure monitoring, chronic pain biofeedback, or routine diagnostic electrodiagnosis is not supported as a replacement for standard needle EMG and NCS.
QST prognostic/diagnostic utility: QST may provide supplemental information regarding small-fiber function or sensory thresholds but lacks sufficient evidence to be considered definitive for diagnosis across most neuropathic conditions; it is considered investigational/unproven for routine diagnostic use.

Documentation Required

Document clinical indication and diagnosis

Document the clinical indication and diagnosis for all neurophysiologic testing. Required documentation should include: the known or suspected neurologic disorder being evaluated (e.g., peripheral neuropathy, radiculopathy, plexopathy, neuromuscular junction disorder, myopathy, motor neuron disease); relevant history and focused examination findings that prompted testing; and the specific clinical question the test is intended to answer. If nerve conduction studies are performed without concomitant needle EMG, the chart must also document one of the following: anticoagulation therapy, presence of lymphedema, or evaluation specifically for carpal tunnel syndrome.

Known or suspected disorder (e.g., peripheral neuropathy, plexopathy, neuromuscular junction disorder, myopathy, motor neuron disease, radiculopathy)
Relevant history and focused physical exam findings
Specific diagnostic question or rationale for test
When NCS without EMG: document anticoagulation, lymphedema, or evaluation for carpal tunnel syndrome

Denial Risk

sNCT / sensory nerve conduction threshold testing investigational

Sensory nerve conduction threshold testing (sNCT) and similar current perception threshold tests are considered investigational/unproven. Requests for coverage of sNCT/CPT SNCT/G0255 or similar procedures are likely to be denied as not supported by adequate evidence.

G0255 (Current perception threshold/sensory nerve conduction test) — investigational

Billing Rule

Code listing is reference-only

The code list in this policy is for reference only. Codes may be removed or updated; actual reimbursement is governed by the member's plan benefits, state and federal law, and contractual terms. Review plan-specific billing rules and edits before claim submission.

Removed/Excluded or referenced codes include (not exhaustive): 0106T–0110T (QST codes), 0464T, 0778T, 95905–95913, 95860–95887, 95872–95874, 95937, 96002, 96004, A9280, G0255, S3900
Plan, state, federal, and contractual rules determine actual coverage and reimbursement

Prior Authorization

Coverage determination guidance

Coverage determinations are subject to plan-specific requirements and UnitedHealthcare policies in combination with InterQual criteria. Prior authorization or other pre-service review may be required by the member's plan; follow plan portals and authorization workflows for submission and medical necessity review.

InterQual determinations and UnitedHealthcare policy language guide coverage decisions
Check the member's plan for prior authorization requirements before testing

2026-04-01material_change_addedLatest

Clarifies situations where NCS alone (without needle EMG) is acceptable. (material): Added language indicating NCS with or without standard late responses when performed without needle EMG are proven and medically necessary for individuals with listed disorders if they are treated with anticoagulants, have lymphedema, or are being evaluated for carpal tunnel syndrome. Details: NCS without needle EMG allowed for individuals treated with anticoagulants, individuals with lymphedema, or individuals being evaluated for carpal tunnel syndrome.

2026-04-01material_change_addedLatest

Lists specific technologies judged insufficient evidence for efficacy and not medically necessary. (material): Designated macro-EMG, point-of-care/portable NCS-only systems, physiologic wearable seizure/movement monitoring (accelerometers, electrodermal sensors, gyroscopes), SEMG-based seizure monitoring, SEMG, sMMG, QST (including monofilament, pressure-specified, CPT/sNCT), and VEP for glaucoma as unproven and not medically necessary. Details: The policy lists these modalities as unproven/not medically necessary due to insufficient evidence.