Pelvic Floor Dysfunction: Anorectal Manometry and EMG

Anal/urethral sphincter EMG and anorectal manometry are covered when used to evaluate fecal or urinary incontinence, dysfunctional anorectal/bladder elimination, interstitial cystitis, or suspected neurologic causes and when results will be used to guide patient management. Coverage requires a documented complete history and physical, ordering by the treating physician (per 42 CFR 410.32), and these diagnostic tests are generally billed once during the initial diagnostic evaluation with repeats allowed only if the medical record justifies further testing to guide additional therapy.

"Anal or urethral sphincter EMG is medically necessary to evaluate fecal incontinence, urinary incontinence, dysfunctional bladder elimination, or interstitial cystitis when results will be used to ..."

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