Anthem Blue Cross Connecticut MED.00130 Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure Monitoring Form

This document addresses devices that use surface electromyography (sEMG) and electrodermal activity sensor devices to monitor seizures. These devices are proposed as an adjunct in recording and storing data for characterization of seizure events.

Note: This document addresses sEMG devices only. sEMG in combination with video electroencephalographic monitoring (vEEG) is not addressed in this document. For information regarding sEMG in combination with vEEG, please see:

• CG-MED-46 Electroencephalography and Video Electroencephalographic Monitoring

Note: This document addresses the electrodermal activity sensor devices to monitor seizures. For information regarding monitoring using electrodermal activity sensor devices, please see:

• CG-MED-91 Remote Therapeutic and Physiologic Monitoring Services

Note: Please refer to the following related documents for additional information:

• MED.00125 Biofeedback and Neurofeedback

Note: Some benefit plans may exclude coverage of consumer wearable or personal mobile devices (such as a smart phone, smart watch, or other personal tracking devices), including any software or applications.

Position Statement

Investigational and Not Medically Necessary:

The use of surface electromyography (sEMG) or electrodermal activity sensor devices for seizure monitoring is considered investigational and not medically necessary.