Medical Policy

 

Subject: Quantitative Muscle Testing Devices
Document #: MED.00089 Publish Date:    10/17/2018
Status: Reviewed Last Review Date:    09/13/2018

Description/Scope

This document addresses the use of specialized devices or equipment that provide quantitative muscle testing.

Position Statement

Investigational and Not Medically Necessary:

The use of quantitative muscle testing devices is considered investigational and not medically necessary.

Rationale

Quantitative muscle testing has been used in clinical research to quantify muscle strength and an individual’s response to rehabilitation and therapy. However, manual muscle testing is sufficiently reliable for clinical practice. There is insufficient peer-reviewed published scientific evidence that quantitative muscle testing is superior (Keller, 2001).

An updated literature search based on the MEDLINE database through August of 2018 did not identify any new articles that would resolve the issues associated with the use of quantitative muscle testing devices. To date, there is insufficient published literature to support the safety and effectiveness of quantitative muscle testing.

Background/Overview

Various quantitative muscle testing devices or machines have been studied for the use in isometric and isokinetic muscle testing.

The MedX Lumbar and Cervical Extension Machines
These devices are used to provide isometric strength testing, and dynamic and variable resistance training of the muscles of the spine. The lumbar extension machine provides resistance over a full range of isolated lumbar motion (72 degrees) or over a pre-selected limited range. In exercise mode, a compound weight stack provides from 10 to 400 foot pounds of resistance in increments of 1 foot pound. Isometric testing can occur every 3 degrees within the individual’s range of motion. During the test, the computer software plots a strength curve that allows a comparison of the individual’s strength and range of motion to age and gender matched norms. The cervical extension machine provides isometric cervical extension strength testing and variable resistance training. Isometric testing can be performed every 3 degrees through the normal 126-degree range of motion.

Cybex 6000 Testing and Rehabilitation System
The Cybex 6000 is a floor-based dynamometer that provides positioning and positive stabilization for testing musculature at the shoulder, elbow, forearm, wrist, hip, knee, and ankle. Isokinetic testing can be conducted at speeds from 5-500 degrees/sec. Isometric testing can also be performed. After testing, isokinetic exercises are provided for physical therapy rehabilitation.

IsoTechnologies B200 Dynamometer
This dynamometer allows the professional to control the three-dimensional resistance experienced by the subject as they move through a three-dimensional range of motion. This device can be used in conjunction with the EMG systems to better understand trunk muscle co-contraction strategies during free-dynamic lifts.

Definitions

Isokinetic: A muscle contraction in which the maximum tension is generated in the muscle as it contracts at a constant speed over the full range of motion of the joint.

Isometric: In physiology, denoting the condition when the ends of a contracting muscle are held fixed so that contraction produces increased tension at constant overall length.

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When Services are Investigational and Not Medically Necessary:
When the code describes a procedure indicated in the Position Statement section as investigational and not medically necessary.

CPT

 

97799

Unlisted physical medicine/rehabilitation service or procedure [when specified as isometric or isokinetic testing]

 

 

ICD-10 Diagnosis

 

 

All diagnoses

References

Peer Reviewed Publications:

  1. Choi G, Raiturker PP, Kim MJ, et al. The effect of early isolated lumbar extension exercise program for patients with herniated disc undergoing lumbar discectomy. Neurosurgery. 2005; 57(4):764-772.
  2. Hutten MM, Hermens HJ. Reliability of lumbar dynamometry measurements in patients with chronic low back pain with test-retest measurements on different days. Eur Spine J. 1997; 6(1):54-62.
  3. Keller A, Hellesnes J, Brox JI. Reliability of the isokinetic trunk extensor test, Biering-Sorensen test, and Astrand bicycle test: assessment of intraclass correlation coefficient and critical difference in patients with chronic low back pain and healthy individuals. Spine (Phila Pa 1976). 2001; 26(7):771-777.
  4. Levene JA, Seeds RH, Goldberg HM, et al. Trends in isodynamic and isometric trunk testing on the Isostation B200. J Spinal Disord. 1989; 2(1):20-35.
Index

Biodex System 3
Cybex
Isostation B-200
JTECH Tracker Freedom® Wireless Muscle Testing
Kim-Com® Isokinetic Equipment
MedX
Quantitative Muscle Testing

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Document History

Status

Date

Action

Reviewed

09/13/2018

Medical Policy & Technology Assessment Committee (MPTAC) review. Rationale updated.

Reviewed

11/02/2017

MPTAC review. The document header wording updated from “Current Effective Date” to “Publish Date.” Updated Rationale section.

Reviewed

11/03/2016

MPTAC review. Updated Rationale, References and Index sections.

Reviewed

11/05/2015

MPTAC review. Updated Rationale and References sections. Removed ICD-9 codes from Coding section.

Reviewed

11/13/2014

MPTAC review. Updated References.

Reviewed

11/14/2013

MPTAC review. Updated Websites.

Reviewed

11/08/2012

MPTAC review. Updated Rationale and Websites.

Reviewed

11/17/2011

MPTAC review. Updated Websites.

Reviewed

11/18/2010

MPTAC review. Updated References and Websites.

Reviewed

11/19/2009

MPTAC review. References updated.

Reviewed

11/20/2008

MPTAC review. References updated.

Reviewed

11/29/2007

MPTAC review. References updated. The phrase “investigational/not medically necessary” was clarified to read “investigational and not medically necessary.”

New

12/07/2006

MPTAC initial document development.