23 Miss. Code. R. 209-1.23 - Electromyography (EMG) Biofeedback Device

A. Medicaid defines an electromyography (EMG) biofeedback device as a device that uses recording equipment to detect, amplify and display a physiological response.

1. EMG uses surface electrodes that are attached to the skin over a specific muscle or group of muscles.

2. The EMG has an amplifier that is used to record the small electrical signals that are produced by contraction of the muscle fibers. These signals are amplified and converted into auditory and/or visual signals for display.

3. Biofeedback instruction can teach a patient to learn to modify or reinforce voluntary control of specific responses.

B. Medicaid covers for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity for rental up to three (3) months, then requires recertification when one (1) or more of the following treatments are prescribed:

1. The beneficiary is in a prescribed therapeutic exercise program,

2. The beneficiary has musculoskeletal pain,

3. The beneficiary has musculoskeletal stress related injuries, or

4. The beneficiary is on a pre-chronic pain and headache program.

C. After the three (3) month rental period, the device may be recertified when documentation demonstrates desired outcomes are being achieved. The DME provider must thoroughly document that the beneficiary is capable of using and understanding the mechanism of biofeedback.

Notes

23 Miss. Code. R. 209-1.23

42U.S.C. § 1395m; Miss. Code Ann. §§ 43-13-117(17), 43-13-121.

Amended 9/1/2018