Medical Policy: 02.01.08
Original Effective Date: December 2000
Reviewed: September 2014
Revised: August 2009
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.
Computerized Dynamic Posturography (CDP) is a unique assessment technique used to objectively quantify and differentiate among the wide variety of possible sensory, motor and central adaptive impairments to balance control.
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 diagnose pathology or be used to localize the site of a lesion.
CDP comprises three functional test protocols:
- Sensory Organization Test (SOT): The SOT protocol objectively identifies abnormalities in the patient’s use of the three sensory systems that contribute to postural control: somatosensory, visual and vestibular. During the SOT, useful information delivered to the patient’s eyes, feet and joints is effectively eliminated through calibrated sway referencing of the support surface and/or visual surround, which tilt to directly follow the patient’s anteroposterior body sway. By controlling the usefulness of the sensory (visual and proprioceptive) information through sway referencing and/or eyes opened/closed conditions, the SOT protocol systematically eliminates useful visual and/or support surface information and creates sensory conflict situations. These conditions isolate vestibular balance control, as well as stress the adaptive responses of the central nervous system. In short, patients may display either an inability to make effective use of individual sensory systems, or inappropriate adaptive responses, resulting in the use of inaccurate sense(s).
- Motor Control Test (MCT): The MCT assesses the ability of the automatic motor system to quickly recover following an unexpected external disturbance. Sequences of small, medium or large platform translations (scaled to the patient’s height) in forward and backward directions elicit automatic postural responses.
- Functional implications: Automatic postural responses are the first line of defense against a fall following unexpected external disturbances to balance. To be effective in this capacity, responses must be timely and well coordinated between the two legs. As response latencies increase and/or amplitudes decrease outside normal ranges, effectiveness is reduced and patients tend to sway farther in response to disturbances. Patient’s with abnormally strong responses tend to over-correct and oscillate back and forth. When responses are asymmetrical between the two legs, patients are at increased risk for instability during tasks such as walking and reaching when the less effective leg is the primary means of postural support.
- When combined with the sensory organization test (SOT), the MCT results are useful in differentiating among normal responses, true pathological conditions and exaggerated sway responses.
- Automatic response latency information is utilized as part of the diagnostic process. Prolonged latencies are evidence of musculoskeletal/biomechanical problems and/or pathology within the long loop pathways including the peripheral nerves, ascending and descending spinal pathways, and brain structures. When prolonged latencies are documented by MCT, the EMG component is helpful in further localizing the deficit within the peripheral nerves or central pathways.
- Adaptation Test (ADT): The ADT assesses a patient’s ability to minimize sway when exposed to surface irregularities and unexpected changes in support surface inclination. Encounters with surface irregularities and changes in inclination of the support surface are common in daily life activities. Patients performing abnormally in the ADT tend to have difficulty under these conditions.
The NeuroCom EquiTest® is a dynamic posturography device that received 510(k) marketing clearance from the U.S. Food and Drug Administration (FDA). Other dynamic posturography device makers include Micromedical Technology, Metitur, and Vestibular Technologies.
Based on the peer reviewed literature there is lack of reference standards for Computerized Dynamic Posturography (CDP), which makes it difficult to determine how the results can be applied in clinical care. There are also no studies that demonstrate the clinical utility of the test, by leading to changes in the management that improves health outcomes. As a result of these deficiencies in the evidence, Computerized Dyanamic Posturography (CDP) is considered investigational for all indications.
Computerized Dynamic Posturography (CDP) 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 Computerized Dynamic Posturography testing.
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.
- 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].
- 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.
- Balaguer Garcia R, Pitarch Corresa S, Baydal Bertomeu JM, Morales Suarez-Varela MM. Static posturography with dynamic tests. Usefulness of biomechanical parameters in assessing vestibular patients. Acta Otorrinolaringol Esp. 2012 Sep-Oct;63(5):332-8.
- Ganesan M, Pasha SA, Pal PK, Yadav R, Gupta A. Direction specific preserved limits of stability in early progressive supranuclear palsy: a dynamic posturographic study. Gait Posture. 2012 Apr;35(4):625-9.
- NeuroCom. Computerized Dynamic Posturography (CDP). www.onbalance.com
- American Academy of Otolaryngology-Head and Neck Surgery. Practice Management Posturography. www.ent.org
Date Reason Action
December 2010 Annual review Policy renewed
December 2011 Annual review Policy renewed
December 2012 Annual review Policy renewed
October 2013 Annual review Policy renewed
September 2014 Annual review Policy renewed
Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
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and therefore are subject to change without notice.
*Current Procedural Terminology © 2012 American Medical Association. All Rights Reserved.