Payer PolicyActive
Gait Analysis and Electrodynogram
AETNA-CPB-0263
Aetna
Effective: May 4, 2023
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Gait (motion) analysis, dynamic electromyography (surface and fine‑wire), electrodynogram, and wearable running‑gait devices are considered experimental/investigational and therefore not covered for any indication. Aetna cites lack of established effectiveness and provides no coverage criteria — related CPT codes are not covered when the CPB selection criteria apply.
Coverage Criteria Preview
Key requirements from the full policy
"Instrumented gait analysis collecting kinetic, kinematic and poly-EMG data for preoperative planning in patients with upper motor neuron syndrome and gait dysfunction (example: spastic equinovarus ..."
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