Neurophysiologic Testing and Monitoring (for Pennsylvania Only)

Coverage Summary & Scope

Policy Number CS082PA.U (status: CURRENT) defines UnitedHealthcare's Pennsylvania-only coverage criteria for neurophysiologic testing and monitoring, effective April 1, 2026. The scope covers electrodiagnostic testing (NCS, needle EMG), other neurophysiologic modalities, applicable CPT/HCPCS codes, performance and supervision standards, and evidence summaries. The policy applies only to the state of Pennsylvania and references Pennsylvania Exceptions, Title 55, Chapter 1101 for exceptions and case-by-case evaluation.

High-level coverage stance is mixed: certain tests and indications are identified as proven and medically necessary (e.g., combined NCS and needle EMG for conditions such as peripheral neuropathy, plexopathy, neuromuscular junction disorders, myopathy, motor neuron disease, radiculopathy, and for treatment guidance), while multiple technologies and tests are listed as unproven and not medically necessary due to insufficient evidence (including point-of-care/portable automated NCS devices that test only distal motor latencies/velocities, macro-EMG, surface EMG/SEMG, sMMG, quantitative sensory testing (QST) variants, wearable seizure/movement monitors, and VEP for glaucoma).

Key threshold metrics (summary)

False Alarm Rate (pooled)Overall FAR ~2.1 per 24 h (pooled); wrist-worn ~2.5/24 h; surface devices ~0.96/24 h

Wearable seizure detection pooled sensitivityPooled sensitivity for tonic-clonic seizures ≈ 0.91 (91%)

icVEP pooled diagnostic exampleMeta-analysis example: icVEP sensitivity ~77%, specificity ~93%

icVEP SNR cutoff examplesReported SNR abnormal cutoffs: SNR ≤1 (some studies); alternative optimal cutoffs ≈0.85–0.93

sEMG RMS accuracy in myogenous TMDReported diagnostic accuracy for sEMG RMS: sensitivity ~60%–80%, specificity ~60%–80%

Removed CPT/HCPCS codesCodes removed: 95999 and A9279 (effective 04/01/2026)

Unproven and Not Medically Necessary

Not covered due to insufficient evidence:

Nerve conduction studies for all other conditions
Non-invasive automatic, portable, or automated point-of-care nerve conduction monitoring systems that test only distal motor latencies and conduction velocities for the purpose of electrodiagnostic testing
Macroelectromyography (macro-EMG) testing
Physiologic monitoring of seizure and/or movement disorder symptoms using wearable devices with accelerometers, electrodermal sensors, or gyroscopes (e.g., wrist-devices, smartwatches)
SEMG based seizure monitoring systems

Guideline Recommendations and Evidence Summaries

Electrodiagnostic (EDX) testing comprises nerve conduction studies (NCS) and electromyography (EMG). NCS assess conduction velocity, latency, and amplitude of peripheral nerves and may include late responses (F-wave, H-reflex). EMG includes needle EMG and surface EMG (SEMG); needle EMG requires insertion of needles and is typically performed by trained physicians. AANEM guidance emphasizes that a properly performed EDX evaluation usually includes both NCS and needle EMG, with needle EMG performed by a physician specially trained in electrodiagnostic medicine and NCS performed by a trained physician or trained individual under direct supervision. The policy notes that certain technologies lack sufficient evidence, including portable/point-of-care automated NCS devices that do not produce real-time waveforms, SEMG and related SEMG-based seizure monitoring systems, surface mechanomyography (sMMG), macro-EMG, and many QST applications.

Procedure and Device Codes

Referenced Procedure Codes (general list - inclusion does not denote coverage)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.

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Codes for tests listed as Unproven / Not Medically NecessarymixedNot Covered

0106T	QST (listed among QST/quantitative sensory testing codes which policy states are unproven/not medically necessary).
0107T	QST.
0108T	QST.
0109T	QST.
0110T	QST.
0464T	Visual evoked potential for glaucoma (policy states VEP testing for glaucoma is unproven/not medically necessary).
0778T	sMMG (policy lists sMMG as unproven/not medically necessary).
96002	Dynamic surface electromyography (SEMG-related) - listed as unproven/not medically necessary when surface EMG is unproven.
S3900	Surface electromyography (SEMG) - unproven/not medically necessary.
G0255	Current perception threshold / SNCT (QST-related) - unproven/not medically necessary.

Removed codes in latest revisionmixedNot Covered

95999	Unlisted electrophysiological procedure (removed per 04/01/2026 summary of changes).
A9279	Electroencephalogram, other; ambulatory (removed per 04/01/2026 summary of changes).

FDA device product codes referenced (informational)mixed

IKN	EMG devices (Class II) - informational.
LLN	Vibration threshold measurement device (QST) - informational.
GXB	Esthesiometer / temperature discrimination / QST - informational.
GWI	2-point discriminator (QST) - informational.
LQW	Temperature discrimination test (QST) - informational.
JXE	Point-of-care nerve conduction devices (Class II) - informational.
POS	Physiologic recording of movement/seizure monitoring (Class II) - informational.
GYD	Physiologic recording device product code - informational.
GWE	Evoked response photic stimulators (Class II) - informational.
HLX	Evoked response photic stimulators - informational.

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Listing of procedure and diagnosis codes in the policy is for reference only and does not imply that a listed service is covered; benefit coverage is determined by federal, state, or contractual requirements and applicable laws.

Codes 95873 and 95874 are described in the policy as add-on guidance procedures to be reported separately in addition to the primary procedure when used for electrical stimulation or needle EMG guidance in conjunction with chemodenervation.

CPT/HCPCS codes 95999 and A9279 were removed from the policy effective 04/01/2026; billing systems and claim submissions should be updated to reflect these removals per the policy's revision history and provider billing guidance.

This policy applies only to Pennsylvania and requests not meeting PARP criteria will be evaluated case-by-case; providers should reference Pennsylvania Exceptions, Title 55, Chapter 1101 when determining applicability.

Provider Requirements, Documentation, and Billing Actions

Documentation Required

Pennsylvania-only applicability

Policy applies only to the state of Pennsylvania. Requests not meeting PARP criteria will be evaluated case-by-case. Refer to Pennsylvania Exceptions, Pennsylvania Code, Title 55, Chapter 1101 for details.

Documentation Required

Performance and supervision standards

Needle EMG must be performed by a physician specially trained in electrodiagnostic (EDX) medicine. Nerve conduction studies should be performed by a trained physician or a trained individual under direct supervision; the physician should supervise data collection and review results in real time or be immediately available per AANEM recommendations.

Definitions and Key Thresholds

NCS: Nerve Conduction Studies (NCS) assess conduction velocity, latency and amplitude of peripheral nerves and may include late responses such as F-wave and H-reflex.

EMG: Electromyography (EMG) refers to needle EMG when needles are inserted into muscle to assess muscle and nerve function; needle EMG is typically performed by a physician specially trained in EDX medicine.

SEMG: Surface EMG (SEMG) records electrical activity from skin electrodes and is listed in this policy as an unproven/not medically necessary modality for many diagnostic uses.

QST: Quantitative Sensory Testing (QST) is a noninvasive assessment of sensory nerve function using stimuli such as touch, vibration, temperature, and includes monofilament testing, pressure-specified sensory testing, and current perception threshold (CPT) / sensory nerve conduction threshold (sNCT) tests; the policy deems many QST applications unproven/not medically necessary.

FAR: False Alarm Rate (FAR) is reported as events per 24 hours and is used to summarize wearable seizure detection performance.

GTCS: Generalized tonic-clonic seizure (GTCS) and FBTCS: Focal to bilateral tonic-clonic seizure (FBTCS) are seizure types referenced in guidance on wearable device detection.

icVEP: Isolated-check visual evoked potential (icVEP) is an electrophysiological test measuring visual pathway function using signal-to-noise ratio (SNR) metrics; small studies report SNR cutoff examples such as ≤1 or ~0.85–0.93 for abnormal results.

Evidence Sources

Source	Key finding/notes
AANEM guidance	Defines proven/medically necessary uses for NCS with/without late responses and when performed with needle EMG (peripheral neuropathy, plexopathy, neuromuscular junction disorders, myopathy, motor neuron disease, radiculopathy, treatment guidance); NCS without EMG allowed in anticoagulated individuals, lymphedema, and carpal tunnel evaluation.
Policy - Unproven/Not Medically Necessary list	Lists tests considered unproven/not medically necessary due to insufficient evidence: point-of-care/portable automated NCS devices, macro-EMG, wearable seizure/movement monitors (accelerometer/EDA/gyroscope), SEMG systems, sEMG, sMMG, QST (including CPT/sNCT), and VEP for glaucoma.
Naganur et al. 2022 (systematic review/meta-analysis)	Pooled sensitivity ~0.91 for tonic-clonic seizures detection by noninvasive wearables; overall FAR 2.1/24h (wrist 2.5/24h; surface devices 0.96/24h) — indicates high sensitivity but notable false alarm rates and heterogeneity.
Halford et al. 2017 (sEMG trial)	Wearable sEMG over biceps detected 29/29 optimally placed GTCS (100%) but overall detection 76% (35/46); PPV low and FAR ~2.52/24h; skin irritation common (28%) and 9% withdrawal — feasible but limitations in false positives and tolerability.
Li et al. 2025 (icVEP meta-analysis)	Pooled icVEP diagnostic performance for glaucoma: sensitivity ~77% and specificity ~93% — promising but limited by heterogeneity and small studies; VEP for glaucoma considered weak evidence overall.
Murphy et al. 2025 / AAN / AANEM reviews on QST	QST evidence overall weak/heterogeneous; QST should not be sole diagnostic method; AAN gives Level B for some QST use in diabetic neuropathy but overall reproducibility/method issues limit utility; sNCT investigational per AANEM.
Point-of-care NCS evidence (preliminary studies)	Preliminary small case series and device 510(k) clearances exist, but peer-reviewed evidence is weak; policy lists such automated portable devices as unproven/not medically necessary.
FDA device classifications	Multiple relevant device product codes and Class II 510(k) clearances exist (e.g., JXE for point-of-care NCS; POS/GYD for physiologic recording; GXB/LLN/LQW for QST devices), noted as informational but not determinative for coverage.
Policy Description and Performance/Supervision standards	States that properly performed EDX usually includes both NCS and needle EMG and that needle EMG should be performed by specially trained physicians; supervision requirements follow AANEM guidance.
Evidence summaries / systematic reviews on wearables and movement devices	Wearable movement devices (e.g., PKG, KinetiGraph, NIMBLE, smartphone sensors) show variable validity, small studies, and uncertain impact on clinical outcomes; some studies report management changes but need larger trials.
Applicable Codes / Policy history	Policy lists QST, VEP, sMMG, sEMG, point-of-care NCS, and related CPT/HCPCS codes as referenced; CPT/HCPCS codes 95999 and A9279 were removed effective 04/01/2026.

Policy Revision Timeline

04/01/2026code_removalLatest

Removed CPT/HCPCS codes 95999 and A9279.

04/01/2026supporting_information_updated

Supporting information updated: Description of Services, Clinical Evidence, FDA, and References sections revised to reflect current information.

04/01/2026prior_version_archived

Archived previous policy version CS082PA.T.