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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 Medicare will consider the use of short-latency somatosensory evoked potentials (SEPs) to 
be medically reasonable and necessary to assist in the diagnosis of certain neuropathologic states (as described 
  
  below) to provide information for treatment decisions and also for intraoperative electrophysiological 
monitoring during spinal surgeries in which there is risk of additional nerve or spinal cord injury. However, it 
is not anticipated that such monitoring will be medically necessary for the typical cervical or lumbar root 
decompression procedures. You can find this rule in the Local Coverage Determination (LCD) - 
Somatosensory Testing (L34624) - Effective October 28, 2021. 
 
The rules say that SEPs are used to evaluate the more proximal segments of nerves and the integrity of the 
central somatosensory pathways when abnormality of conduction through the brain and/or brainstem, spinal 
cord, and/or peripheral nerves is suspected. This utilization would include conditions such as multiple sclerosis, 
cervical spondylosis with myelopathy, coma, spinal cord trauma, myoclonus, Friedreichs ataxia, 
syringomyelia, spinal cord tumors, spinal stenosis and other conditions where there is spinal cord compression. 
You can find this rule in the Local Coverage Determination (LCD) - Somatosensory Testing (L34624) - 
Effective October 28, 2021. 
 
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 (L36524) - Effective December 1, 2019. 
 
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 (L36524) - Effective December 1, 2019.  
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. 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 
 
You can find this rule in the Local Coverage Determination (LCD) - Intraoperative Neurophysiological Testing 
(L34623) - Effective July 28, 2022. 
 
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.