Payer PolicyActive
Surface Scanning and Macro Electromyography
AETNA-CPB-0112
Aetna
Effective: March 22, 2023
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Aetna considers high‑density/surface scanning/paraspinal/macro EMG, surface EMG for nocturnal bruxism, the Neurophysiologic Pain Profile/spine matrix scan, and spinoscopy experimental/investigational and therefore not covered because their reliability, validity, and clinical value have not been established. Conventional needle EMG and use of surface electrodes for EMG biofeedback are not affected and remain medically necessary for appropriate indications.
Coverage Criteria Preview
Key requirements from the full policy
"Surface EMG devices for diagnosis and/or monitoring of nocturnal bruxism and all other indications; (listed as experimental/investigational — see Limitations)"
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