Evoked Potential Studies (CPB 0181, reviewed 2026-04-21)
Summary
Aetna's Clinical Policy Bulletin 0181 sets out which evoked potential studies are medically necessary and which are experimental, investigational or unproven. Somatosensory evoked potentials are medically necessary to evaluate acute anoxic encephalopathy within 3 days of the anoxic event, suspected brain death, and clinically silent brain lesions in multiple sclerosis suspects, among other listed indications. Visual evoked potentials are medically necessary to diagnose and monitor multiple sclerosis, and brainstem auditory evoked responses are medically necessary to diagnose suspected acoustic neuroma and to screen infants and children under 3 years of age for hearing loss. Cervical vestibular evoked myogenic potentials are medically necessary for vertigo from semicircular canal dehiscence syndrome after a comprehensive evaluation with inconclusive results, and for bilateral sensorineural hearing loss after cochlear implantation. Pre-operative somatosensory evoked potentials of the bilateral tibial pathways before scoliosis surgery and somatosensory evoked potentials for carpal tunnel syndrome are listed as experimental, investigational or unproven.
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