So...even insurance company says when you present with neuropathic symptoms, large fiber is ruled out, and emgs are negative, a skin punch biopsy is medically necessary.


The assessment of nerve fibers is a component of evaluating peripheral nerve disease. Most nerve disease targets the small nerve fibers (as opposed to large nerve fibers). This document addresses the pathological analysis from skin biopsy specimens of intraepidermal nerve fiber (IENF) density for the diagnosis of small-fiber neuropathy (SFN).

ANTHEM INSURANCE:
Subject: Skin Nerve Fiber Density Testing
Policy #: LAB.00020 Current Effective Date: 07/15/2014
Status: Reviewed Last Review Date: 05/15/2014
Position Statement

Medically Necessary:

Pathological analysis of intraepidermal nerve fiber density for the diagnosis of small-fiber neuropathy is considered medically necessary when all of the following conditions are met:

1. Individual presents with painful sensory neuropathy; AND
2. 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
3. Electromyography and nerve-conduction studies are normal and show no evidence of large-fiber neuropathy.

Why, oh why can they order expensive tests, but WONT do a biopsy?
Can anyone help me to understand this?