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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 Somatosensory Evoked Potentials and Responses (SEPs/SERs) are appropriate for the 
following indications: 
 
1. Spinal cord trauma 
2. Degenerative, non-traumatic spinal cord lesions (e.g., cervical spondylosis with myelopathy) 
3. Multiple sclerosis 
4. Spinocerebellar degeneration 
5. Myoclonus 
6. Coma 
7. Intraoperative monitoring 
8. Subacute combined degeneration 
9. Other diseases of myelin (e.g., adrenoleukodystrophy, adrenomyeloneuropathy, metachromatic 
leukodystrophy, and Pelizaeus-Merzbacher disease) 
10. Syringomyelia 
11. Hereditary spastic paraplegia 
 
You can find this rule in the Local Coverage Determination (LCD) - Neurophysiology Evoked Potentials 
(NEPs) (L34975). 
 
The rules say that 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. Resection of tumors involving the cranial nerves 
b. Cavernous sinus tumors c. Microvascular decompression of cranial nerves 
d. Skull base surgery in the vicinity of the cranial nerves and surgeries of the foramen magnum 
e. Oval or round window graft 
 
5. Endolymphatic shunt for Meniere's disease 
6. Vestibular section for vertigo 
7. Correction of scoliosis or deformity of spinal cord involving traction of the cord 
8. Protection of spinal cord where work is performed in close proximity to cord as in the placement or removal 
of old hardware or where there have been numerous interventions 
9. Spinal instrumentation requiring pedicle screws or distraction 
10. 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 
11. Spinal cord tumors and spinal fractures (with the risk of cord compression) 
12. Neuromas of peripheral nerves of brachial plexus, when there is risk to major sensory or motor nerves 
13. Surgery or embolization for intracranial AV malformations 
14. Surgery for arteriovenous malformation of spinal cord 
15. Embolization of bronchial artery AVMs or tumors 
16. Cerebral vascular aneurysms 
17. Surgery for intractable movement disorders 
18. Arteriography, during which there is a test occlusion of the carotid artery 
19. Circulatory arrest with hypothermia (does not include surgeries performed under circulatory bypass [e.g., 
CABG, ventricular aneurysms]) 
20. Distal aortic procedures, where there is risk of ischemia to spinal cord 
21. Leg lengthening procedures, where there is traction on sciatic nerve or other nerve trunks 
22. Basal ganglia movement disorders 
23. Surgery as a result of traumatic injury to spinal cord/brain 
24. Deep brain stimulation, and 
25. Certain thyroid surgeries 
 
You can find this rule in the Local Coverage Determination (LCD) - Intraoperative Neurophysiological Testing 
(L35003). 
 
The rules say that below is a list of common disorders where an electromyography (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. At times, immediately prior to botulinum toxin injection, for localization. 
8. At times, immediately prior to injection of phenol or other substances for nerve blocking or 
chemodenervation. 
 
You can find this rule in the Local Coverage Determination (LCD) - Nerve Conduction Studies and 
Electromyography (L35081). 
 
The rules say that nerve conduction studies (NCS) are used to measure action potentials resulting from 
peripheral nerve stimulation which are recordable over the nerve or from an innervated muscle. With this 
technique, responses are measured between two sites of stimulation, or between a stimulus and a recording 
site. The dichotomy into axonal and demyelinating neuropathies provides a practical means of correlating electrical abnormalities with major pathophysiologic changes in the nerve. Electrical studies can be of help in 
localization of an abnormality, and in distinguishing one variety of neuropathy from another: for example, 
diffuse vs. multifocal; axonal vs. demyelinating. Such distinction has diagnostic value. Specific classification 
of nerve injuries into neuropraxia and axonotmesis can be made on the basis of conduction studies and 
electromyography. Such classification has a bearing on prognosis and treatment. 
 
1. Focal neuropathies or compressive lesions such as carpal tunnel syndrome, ulnar neuropathies or root 
lesions, for localization. 
2. Traumatic nerve lesions, for diagnosis and prognosis. 
3. Diagnosis or confirmation of suspected generalized neuropathies, such as diabetic, uremic, metabolic or 
immune. 
4. Repetitive nerve stimulation in diagnosis of neuromuscular junction disorders such as myasthenia gravis, 
myasthenic syndrome. 
5. There may be other instances, not detailed here, where NCS may be of use. Not all possible or potential 
indications are addressed here. 
 
You can find this rule in the Local Coverage Determination (LCD) - Nerve Conduction Studies and 
Electromyography (L35081). 
 
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.