Aetna considers pyrophosphate muscle scan in the evaluation of myalgia and myositis experimental and investigational because there is no clinical evidence to support the use of pyrophosphate muscle scan in the evaluation of myalgia and myositis.
Aetna considers the Myoglobinuria Test Panel experimental and investigational because there is no clinical evidence to support the use of the Myoglobinuria Test Panel.
Aetna considers home medical diagnostic tests (e.g., food allergy and intolerance testing, heavy metal/lead poisoning testing, and water testing) experimental and investigational for the diagnosis of familial visceral myopathy because the effectiveness of this approach has not been established.
For SLCO1B1 testing for statin-induced myopathy, see CPB 0140 - Genetic Testing.
For myositis antibody panel, see CPB 0866 - Rheumatic Diseases: Selected Tests.
Myalgia is muscular pain or tenderness. Muscle pain can also involve ligaments, tendons and fascia, the soft tissues that connect muscles, bones and organs together. Myositis is an inflammation or swelling of the muscles and may be caused by injury, infection or an autoimmune disorder.
Pyrophosphate Muscle Scan:
The pyrophosphate muscle scan or scintigraphy, is a nuclear imaging technique evaluating the uptake of technetium-99m pyrophosphate to reflect muscle viability and activity. According to Rider and colleagues, 2002, several types of scintigraphy have been used to image the muscles of patients with idiopathic inflammatory myopathies, including antimyosin, 99mtechnetium pyrophosphate, and 67gallium, each demonstrating uptake in inflamed, but not atrophied, muscles. The clinical usefulness of scintigraphy in the assessment of myositis is not clear.
The Myoglobinuria Test Panel:
The Myoglobinuria Test Panel is used for individuals with exercise intolerance related weakness, pain, cramping and idiopathic myoglobulinuria. The test, using muscle tissue, detects specific enzymes related to metabolic function. Diseases tested for include Phosphofructokinase deficiency (PFK), McArdle's disease, Tarui's disease, Phosphoglycerate kinase deficiency (PGK), Phosphoglycerate mutase deficiency (PGAM), Lactate Dehydrogenase deficiency (LDH), Glycogen, Phosphorylase A+ total deficiency (Ph), Phosphorylase B kinase deficiency (PhK), Carnitine Palmitoyltransferase 2 deficiency (CPT2) and Myoadenylate Deaminase deficiency (MAD). The Myoglobinuria Test Panel is a proprietary test of Athena Diagnostics. There is no clinical evidence to support the use of the Myoglobinuria Test Panel.
Home Medical Diagnostic Tests for Familial Visceral Myopathy:
Familial visceral myopathy is a rare condition in which the duodenum is dilated and the muscles don't function normally; thus, affecting the movement of digestive waste material through the intestines. The symptoms of familial visceral myopathy are similar to that caused by an intestinal obstruction. However, there is a lack of evidence regarding the effectiveness of home testing (e.g., food allergy and intolerance testing, heavy metal/lead poisoning testing, and water testing) for the diagnosis of familial visceral myopathy.
|CPT Codes / HCPCS Codes / ICD-9 Codes|
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes not covered for indications listed in the CPB:|
|83615||Lactate dehydrogenase (LD), (LDH)|
|84311||Spectrophotometry, analyte not elsewhere specified|
|HCPCS codes not covered for indications listed in the CPB:|
|A9538||Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries|
|ICD-10 codes not covered for indications listed in the CPB (not all inclusive) :|
|M60.000 - M60.9||Myositis|