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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that neurogenic disorders can be distinguishable from myopathic disorders by a carefully 
performed electromyography (EMG). For example, both polymyositis and ALS (Amyotrophic Lateral 
Sclerosis) produce manifest weakness. The former carries a very different prognosis and treatment than the 
latter. An EMG is valuable in making this distinction. Similarly, classification of nerve trauma into axonal vs. 
demyelinating categories, with corresponding differences in prognoses, are possible with EMG. Below is a list 
of common disorders where an EMG, in tandem with properly conducted NCS, will be helpful in diagnosis: 
 
1. Nerve compression syndromes, including carpal tunnel syndrome and other focal compressions. 
2. Radiculopathy - cervical, lumbosacral. 
3. Mono/polyneuropathy - metabolic, degenerative, hereditary. 
4. Myopathy - including poly-and dermatomyositis, myotonic and congenital myopathies. 
5. Plexopathy - idiopathic, trauma, infiltration. 
6. Neuromuscular junction disorders - myasthenia gravis. Single fiber EMG is of special value here. 
7. When clinically necessary, immediately prior to botulinum toxin injection, for localization. 
8. When clinically necessary, immediately prior to injection of phenol or other substances for nerve blocking or 
chemodenervation. 
 
There may be other instances, not detailed here, where EMG may be of use. You can find this rule in the Local 
Coverage Determination (LCD) - Nerve Conduction Studies and Electromyography (L34859) - Effective 
October 1, 2019. 
 
The rules say that intraoperative neurophysiological testing may be used to identify/prevent complications 
during surgery on the nervous system, its blood supply, or adjacent tissue. Some high-risk patients may be 
candidates for a surgical procedure only if monitoring is available. To establish medical necessity the following 
guidelines must be followed. Intraoperative testing may be indicated with the following types of surgery: 
 
1. Surgery of the aortic arch, its branch vessels, or thoracic aorta, including internal carotid artery surgery, 
when there is risk of cerebral ischemia 
2. Resection of epileptogenic brain tissue or tumor 3. Resection of brain tissue close to the primary motor cortex and requiring brain mapping 
4. Protection of cranial nerves 
 
a. tumors that are optic, trigeminal, facial, auditory nerves 
b. cavernous sinus tumors 
c. oval or round window graft 
d. endolymphatic shunt for Meniere's disease 
e. vestibular section for vertigo 
f. microvascular decompression of cranial nerves 
 
5. Correction of scoliosis or deformity of spinal cord involving traction on the cord 
6. Protection of spinal cord where work is performed in close proximity to cord as in the removal of old 
hardware or where there have been numerous interventions 
7. Spinal instrumentation requiring pedicle screws or distraction 
8. Decompressive procedures on the spinal cord or cauda equina carried out for myelopathy or claudication 
where function of spinal cord or spinal nerves is at risk 
9. Resection of: 
 
a. spinal cord tumors 
b. Neuromas of peripheral nerves or brachial plexus, when there is risk to major sensory or motor nerves 
 
10. Surgery for: 
 
a. intracranial AV malformations 
b. arteriovenous malformation of spinal cord 
c. surgery for intractable movement disorders 
d. cerebral vascular aneurysms 
e. surgery for intractable movement disorders 
 
11. Arteriography, during which there is a test occlusion of the carotid artery 
12. Circulatory arrest with hypothermia 
13. Distal aortic procedures, where there is risk of ischemia to spinal cord 
14. Leg lengthening procedures, where there is traction on sciatic nerve or other nerve trunks 
15. Basil ganglia movement disorders 
16. Surgery as a result of traumatic injury to spinal cord/brain 
17. Deep brain stimulation 
 
You can find this rule in the Local Coverage Determination (LCD) - Intraoperative Neurophsyiological Testing 
(L34623) - Effective July 30, 2020. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.