Blue Cross Blue Shield of Minnesota Medical Policy

 
 

Medical Policy:
VII-12-008
Topic:
Automated Point-of-Care Nerve Conduction Tests
Section:
Ancillary Services
Effective Date:
April 27, 2020
Issued Date:
May 3, 2021
Last Revision Date:
April 2020
Annual Review:
April 2021
 
 

This policy version was replaced May 2, 2022. To find the newest version, go to https://www.bluecrossmn.com/providers/medical-policy-and-utilization-management, read and accept the Blue Cross Medical Policy Statement, then select “Blue Cross and Blue Shield of Minnesota Medical Policies.” This will bring up the Medical Policy search screen. Enter the policy number without the version number (last 3 digits).

Nerve conductions studies and needle electromyography are considered the gold standard of electrodiagnostic testing. However, the need for specialized equipment and personnel may limit the availability of electrodiagnostic testing for some patients. Portable devices have been developed to provide point-of-care nerve conduction studies. These portable devices have computational algorithms that are able to drive stimulus delivery, measure and analyze the response, and provide a detailed report of study results. Automated nerve conduction could be used in various settings, including primary care, without the need for specialized training or equipment. Proposed uses of automated nerve conduction devices include diagnosing carpal tunnel syndrome and diagnosing peripheral neuropathy, particularly in patients with diabetes.

Automated point-of-care nerve conduction tests currently being marketed include but are not limited to the following:

  • NC-stat® (NeuroMetrix)
  • NeuroMetrix ADVANCE™ (NeuroMetrix)
  • Axon-II™ (PainDx)
  • Neural-Scan™ system (NeuroDiagnostics)
  • Brevio® (Neurotron Medical)
  • VT 3000 (Virtual Medical Systems)
  • XLTEK Neuropath (Excel-Tec)
  • Cadwell Sierra (Cadwell Industries)
  • Cadwell Sierra Ascent (Cadwell Industries)
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Policy Position Coverage is subject to the specific terms of the member's benefit plan.

The use of automated point-of-care nerve conduction tests is considered EXPERIMENTAL/INVESTIGATIVE due to the lack of clinical evidence demonstrating improvement in health outcomes.

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Denial Statements

No additional statements.



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Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. When determining coverage, reference the member’s specific benefit plan, including exclusions and limitations.

Medicaid products may provide different coverage for certain services, which may be addressed in different policies. For Minnesota Health Care Program (MHCP) policies, please consult the MHCP Provider Manual website.

Medicare products may provide different coverage for certain services, which may be addressed in different policies. For Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and/or Local Coverage Articles, please consult CMS, National Government Services, or CGS websites. 

Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.

Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. Codes listed on this policy are included for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. 

These guidelines are the proprietary information of Blue Cross and Blue Shield of Minnesota. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.

Acknowledgements:

CPT® codes copyright American Medical Association® 2022. All rights reserved.

CDT codes copyright American Dental Association® 2022. All rights reserved.