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Medical Policy: 02.01.08
Original Effective Date: December 2000
Reviewed: December 2011
Revised: August 2009
Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the
services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary
based on contract, and individual member benefits must be verified. Wellmark determines medical
necessity only if the benefit exists and no contract exclusions are applicable. This medical
policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document
was developed. Since that time, new technology may have emerged or new medical literature may
have been published. This Medical Policy will be reviewed regularly and be updated as scientific
and medical literature becomes available.
Description:
Dynamic posturography attempts to provide quantitative information about the ability to maintain balance. The patient, wearing a harness to prevent falls, stands on an enclosed platform surrounded by a visual field. By altering the angle of the platform or shifting the visual field, the test assesses movement coordination and the sensory organization of visual, somatosensory, and vestibular information relevant to postural control. Results of posturography have been used to determine what type of information (i.e., visual, vestibular, proprioceptive) can and cannot be used to maintain balance. Dynamic posturography cannot be used to localize the site of a lesion.
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Prior Approval:
Not applicable
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Policy:
Dynamic posturography is considered investigational. There are no available studies in the peer-reviewed literature which demonstrate improved treatment decision-making and/or improved health outcomes based on the results of dynamic posturography testing.
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Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
- 92548 may be used to report computerized dynamic posturography.
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Selected References:
- Furman JM. Role of posturography in the management of vestibular patients. 1995;112:8-15.
- Allum JHJ, Shepard NT. An overview of the clinical use of dynamic posturography in the differential diagnosis of balance disorders. Journal of Vestibular Research 1999;9:223-252.
- Evans, MK Krebs DE. Posturography does not test vestibulospinal function. Otolaryngol Head Neck Surg. 1999 Feb; 120(2):164-73.
- Ruckenstein MJ, Shepard NT. Balance Function Testing; A rational approach. Otolaryngologic Clinics of North America; Vol.33;No3;Jun 2000.
- Amin M, Girardi M, Konrad HR, Hughes L. A comparison of electronystagmography results with posturography findings from the Balance trak 500. Otol Neurol. 2002 Jul;23(4);488-93.
- Morgan SS, Beck WG, Dobie RA. Can posturography identify malingerers? Otol Neurol 2002 Mar;23(2):214-7.
- ECRI Institute. Dynamic Posturography for Balance Disorders. ECRI Institute Custom Hotline Response. 3/20/2007.
- ECRI Institute. Dynamic Posturography for Balance Disorders. Plymouth Meeting (PA): ECRI Institute: 2007 March 20. 9p. [ECRI custom hotline response]. Also available: http://www.ecri.org.
- Ebersbach, G & Gunkel, M. Posturography reflects clinical imbalance in Parkinson’s disease. Mov Disord. 2010 Dec 13. [Epub ahead of print]
- Pang MY, Lam FM, Wong GH, et al. Balance performance in head-shake computerized dynamic posturography: aging effects and test-retest reliability. Phys Ther. 2011 Apr;91(4):598.
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Policy History:
Date Reason Action
December 2010 Annual review Policy renewed
December 2011 Annual review Policy renewed
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Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
*Current Procedural Terminology © 2010 American Medical Association. All Rights Reserved.
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