General Insurance Policies for ENFD Testing

by ascential  

Common Policies Required

Aetna, Blue Cross, United and other major insurance plans including Medicare considers measurement of intra-epidermal nerve fiber density (IENFD) by skin biopsy medically necessary for the diagnosis of small-fiber neuropathy. There are however certain criteria that must be met in order to obtain coverage in most circumstances:

All of the following generally, are criterion and will need to be met for coverage:

  • Individual presents with painful sensory neuropathy; and
  • There is no history of a disorder known to predispose to painful neuropathy (e.g., diabetic
  • neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy); and
  • Physical examination shows no evidence of findings consistent with large-fiber neuropathy, such as reduced or absent muscle-stretch reflexes or reduced proprioception and vibration
  • sensation; and
  • Needle electromyography (EMG) and nerve conduction velocity studies are normal and
  • show no evidence of large-fiber neuropathy.