Neurophysiologic Testing and Monitoring – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers nerve conduction studies (with or without standard late responses) and neuromuscular junction testing only when performed with needle EMG for suspected/known peripheral neuropathy/polyneuropathy, plexopathy, neuromuscular junction disorders (e.g., myasthenia gravis), myopathy, motor neuron disease, radiculopathy, and for treatment guidance; NCS without EMG is allowed only for anticoagulated patients, those with lymphedema, or carpal tunnel evaluation, while macro‑EMG, surface EMG/SEMG, sMMG, quantitative sensory testing, VEP for glaucoma, wearable physiologic seizure/movement monitors, and automated/portable distal‑only NCS devices (and NCS for indications outside the listed conditions) are considered unproven/not medically necessary. Key requirements: documentation of history, exam and differential diagnosis showing medical necessity; adherence to AANEM performance/supervision standards with physician‑performed or physician‑supervised, real‑time on‑site integrated NCS+EMG under one supervising physician; procedure‑specific documentation for neuromuscular junction testing (≥1 motor and 1 sensory NCS in an involved limb and distal + proximal muscles by EMG); and if NCS is done without EMG, document the qualifying clinical reason and immediate physician availability.