CG-MED-50 Visual, Somatosensory and Motor Evoked Potentials

This policy addresses evoked potential testing, including visual evoked potentials (VEPs), somatosensory evoked potentials (SSEPs), and motor evoked potentials (MEPs). Coverage is medically necessary for VEPs to diagnose, evaluate, or monitor multiple sclerosis, neuromyelitis optica, or other demyelinating optic neuropathies, and for suspected optic nerve/chiasm/radiation disorders not explained by MRI/CT or infectious/metabolic causes; SSEPs are medically necessary when results will guide clinical management, including in acute anoxic encephalopathy within 72 hours of onset. VEPs are not covered for other indications (e.g., glaucoma testing, routine infant screening), SSEPs are not covered for other uses, and MEPs are not covered in the non-operative setting when these criteria are not met.

"Visual evoked potentials are consideredmedically necessaryfor the diagnosis, evaluation, or monitoring of any of the following conditions:"