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June 2024 Medical and Pharmacy Policy updates now available
March 1, 2024

We recently revised medical policies 211 and 701 to help you better understand our coverage for electromyography and nerve conduction studies as part of intraoperative neurophysiologic monitoring. We’ve added cross-references in each policy. Please see below for the clarifications.

We’ve posted new, revised, clarified, and retired medical and pharmacy medical policies, effective in June 2024.

Medicare Advantage policies

 Medical policy 132, Medicare Advantage Management

(This document explains whether we use CMS criteria—or our own—to make coverage determinations for our Medicare Advantage members.)

Medicare Advantage section of our medical policy site.

FEP medical policies 

Visit fepblue.org and search for medical policies.

Two policies clarified in February

Name of policy Clarification
Intraoperative Neurophysiologic Monitoring Sensory-Evoked Potentials, Motor-Evoked Potentials, EEG Monitoring medical policy 211 This policy describes intraoperative neurophysiologic monitoring (IONM) and specifies when this monitoring, including electromyography and nerve conduction studies, is medically necessary or investigational. In this policy:
  • We now cross-reference CPT codes used for electromyography in IONM.
  • When requesting authorization for electromyography in IONM, please use the codes specified. This includes both the electromyography and IONM codes.
Electromyography and Nerve Conduction Studies medical policy 701 This policy describes electromyography (EMG) used for diagnostic purposes.
  • We added references to IONM. When using EMG for IONM, CPT codes 95940 or 95941 must be used with an EMG code (also listed in the policy) for coverage for our commercial (HMO/POS, and PPO) and Indemnity members.
  • For medical necessity criteria, please refer to medical policy 211.