Medical Policy: 02.01.19 
Original Effective Date: March 2003 
Reviewed: March 2016 
Revised:  


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:

Quantitative sensory testing, (QST), sometimes referred to as current perception threshold (CPT) testing, sensory nerve conduction threshold testing (sNCT), voltage-activated sensory threshold testing, and pressure-specified sensory testing, has been explored as a way to diagnose sensory and motor neuropathies.  This is a noninvasive test that uses transcutaneous electrical stimuli to evoke a sensory sensation and it is categorized as a quantitative sensory test.  This test has been investigated for a broad range of clinical applications, including evaluation of peripheral neuropathies, detection of carpal tunnel syndrome, spinal radiculopathy, evaluating the effectiveness of peripheral nerve blocks, quantification of hypoesthetic and hyperesthetic conditions and differentiation of psychogenic from neurologic disorders. 

 

QST systems measure and quantify the amount of physical stimuli required for sensory perception to occur in the patient. As sensory deficits increase, the perception threshold of QTS will increase, which may be informative in documenting progression of neurologic damage or disease. QST has not been established for use as a sole tool for diagnosis and management but has been used in conjunction with standard evaluation and management procedures (e.g., physical and neurologic examination, monofilament testing, pinprick, grip and pinch strength, Tinel, Phalen and Roos sign) to enhance the diagnosis and treatment planning process and confirm physical findings with quantifiable data. Stimuli used in QST includes touch, pressure, pain, thermal (warm and cold), or vibratory stimuli.

 

The gold standard for evaluation of myelinated large fibers is the electromyographic nerve conduction study (EMG-NCS). However, the function of smaller myelinated and unmyelinated sensory nerves, which may show pathologic changes before the involvement of motor nerves, cannot be detected by nerve conduction studies. Small fiber neuropathy has traditionally been a diagnosis of exclusion in patients who have symptoms of distal neuropathy and a negative conduction study.

 

Depending on the type of stimuli used, QST can assess both small and large fiber dysfunction. Touch and vibration measure the function of large myelinated A-alpha and A-beta sensory fibers. Thermal stimulation devices are used to evaluate pathology of small myelinated and unmyelinated nerve fibers; they can be used to assess heat and cold sensation as well as thermal pain thresholds. Pressure-specified sensory devices (PSSD) assess large myelinated sensory nerve function by quantifying the thresholds of pressure detected with light, static, and moving touch. Finally, current perception threshold testing involves the quantification of the sensory threshold to transcutaneous electrical stimulation. In current perception threshold testing, typically 3 different frequencies are tested: 5 Hz, designed to assess C fibers; 250 Hz, designed to assess A-delta fibers; and 2,000 Hz, designed to assess A-beta fibers. Results are compared with those of a reference population.

 

Because QST combines the objective physical sensory stimuli with the subject patient response, it is psychophysical in nature and requires patients who are alert, able to follow directions, and cooperative. Psychophysical tests have greater inherent variability, making their results more difficult to standardize and reproduce.

 

The Neurometer® Current Perception Threshold and Medi-Dx 7000™, are among various devices approved by the U.S. Food and Drug Administration to measure the threshold for sensory nerve conduction.

 

American Academy of Neurology (AAN): In a report noted QST is a potentially useful tool for measuring sensory impairment for clinical and research studies. However, QST results should not be the sole criteria used to diagnose pathology”. The AAN indicated that malingering and other nonorganic factors can affect the outcomes of the test results. They also noted that well-designed studies to compare the various types of QST devices and methodologies are indicated and should include patients with abnormalities detected solely by QST.


Prior Approval:

 

Not applicable


Policy:

Quantitative sensory testing, including but not limited to current perception threshold testing,  pressure-specified sensory device testing, vibration perception threshold testing and thermal threshold testing, is considered investigational.

 

There is insufficient evidence that the use of quantitative sensory testing for the noninvasive assessment and quantification of sensory nerve function is as accurate as conventional tests. Questions remain about reference values in normal populations and the reproducibility of test results. In addition, there is a lack of evidence that use of quantitative sensory testing impacts patient management or improves the net health outcome.



Procedure Codes and Billing Guidelines:

  • To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.
  • 0106T Quantitative sensory testing (QST), testing and interpretation per extremity; using touch pressure stimuli to assess large diameter sensation.
  • 0107T Quantitative sensory testing (QST), testing and interpretation per extremity; using vibration stimuli to assess large diameter fiber sensation.
  • 0108T Quantitative sensory testing (QST), testing and interpretation per extremity; using cooling stimuli to assess small nerve fiber sensation and hyperlgesia.
  • 0109T Quantitative sensory testing (QST), testing and interpretation per extremity; using heat-pain stimuli to assess small nerve fiber sensation and hyperalgesia.
  • 0110T Quantitative sensory testing (QST), testing and interpretation per extremity; using other stimuli to assess sensation. 
  • G0255 Current perception threshold or sensory nerve conduction test, (SNCT) per limb, any nerve.

Selected References:

  • Yamashita, T., Kanaya, K., Sekine, M., Takebayashi, T., Kawaguchi, S., Katahira, G.
    A quantitative analysis of sensory function in lumbar radiculopathy using
    current perception threshold testing. Spine 2002 Jul 15; 27(14): 1567-70.
  • Technology review: the Neurometer Current Perception Threshold (CPT). AAEM
    Equipment and Computer Committee. American Association of Electrodiagnostic
    Medicine. Muscle Nerve 1999 Apr; 22(4):523-31.
  • Park R, Wallace MS, Schulteis G. Relative sensitivity to alfentanil and reliability of current perception threshold vs. von Frey tactile stimulation and thermal sensory testing. J Peripher Nerv Syst 2001;(6)4:232-40.
  • Shy ME, Frohman EM et al. Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2003 Mar 25;60(6):898-904
  • Wylde V, Palmer S, Learmonth ID et al. Test-retest reliability of quantitative sensory testing in knee osteoarthritis and healthy participants. Osteoarthritis cartilage. 2011 Jun; 19(6):655-8. Epub 2011 Feb 15.
  • Scott AC, McConnell S, Laird B et al. Quantitative sensory testing to assess the sensory characteristics of cancer-induced bone pain after radiotherapy and potential clinical biomarkers of response. Eur J Pain. 2011 Jun 11. [Epub ahead of print].
  • Heldestad V, Linder J, Sellersjo L et al. Reproducibility and influence of test modality order on thermal perception and thermal pain thresholds in quantitative sensory testing. Clin Neurophysiol. 2010 Nov; 121(11):1878-85. Epub 2010 May 15.
  • Suokas AK, Walsh DA, McWilliams DF, et al. Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2012 Jul 13. [Epub ahead of print]
  • Moloney NA, Hall TM, Doody CM. Reliability of thermal quantitative sensory testing: A systematic review. J Rehabil Res Dev. 2012 Apr;49(2):191-208.
  • ECRIExternal Site Institute. Quantitative Sensory Testing for Measuring Sensory Stimulation. Plymouth Meeting (PA): ECRI Institute; 2012 March 12. [Hotline response].
  • American Academy of Neurology. Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. National Guidline ClearinghouseExternal Site 
  • Ahmad S, De Oliveira GS, Jr., Bialek JM, et al. Thermal quantitative sensory testing to predict postoperative pain outcomes following gynecologic surgery. Pain Med. May 2014;15(5):857-864. PMID 24517836
  • Vuilleumier PH, Biurrun Manresa JA, Ghamri Y, et al. Reliability of quantitative sensory tests in a low back pain population. Reg Anesth Pain Med. Nov-Dec 2015;40(6):665-673. PMID 26222349

Policy History:

  • March 2016 - Annual Review, Policy Renewed
  • April 2015 - Annual Review, Policy Renewed
  • June 2013 - Annual Review, Policy Renewed
  • August 2012 - Annual Review, Policy Renewed
  • September 2011 - 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 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 © 2012 American Medical Association. All Rights Reserved.