Medical Policy: 02.01.19 

Original Effective Date: March 2003 

Reviewed: March 2021 

Revised: March 2020 



This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.


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.



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 thermal sensory testing element measures the thresholds for four sensory sub-modalities:

  • Warm sensation (WS), for normal subjects, usually at 1- 2ºC above adaptation temperature (C fiber mediated sensation)
  • Cold sensation (CS), for normal subjects, usually at 1- 2ºC below adaptation temperature (A-delta fibers mediated sensation)
  • Heat induced pain (HP), threshold around 45ºC (mostly C fiber mediated sensation, with some involvement of A-delta fibers)
  • Cold induced pain (CP), the most variable and difficult to assess of all previous modalities, at about 10º C (combination of both C and A-delta fiber mediated sensation)


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.


Practice Gudelines and Position Statements

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.


American Association of Neuromuscular & Electrodiagnostic Medicine 

The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) published a technology literature review on QST (light touch, vibration, thermal, pain). The review concluded that QST is a reliable psychophysical test of large- and small-fiber sensory modalities but is highly dependent on the full patient cooperation. Abnormalities do not localize dysfunction to the central or peripheral nervous system, and no algorithm can reliably distinguish between psychogenic and organic abnormalities. The AANEM review also indicated that QST has been shown to be reasonably reproducible over a period of days or weeks in normal subjects, but, for individual patients, more studies are needed to determine the maximum allowable difference between 2 QSTs that can be attributed to experimental error.


Regulatory Status

The Neurometer® Current Perception Threshold, Nk Pressure-Specified Sensory Device™, Pressure-Specified Sensory Device, Vibration Perception Threshold CASE IV, 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.


Prior Approval:

Not applicable



Quantitative sensory testing, including but not limited to current perception threshold testing, including computer assisted sensory examinations, pressure-specified sensory device testing, vibration perception threshold testing, monofilament 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:

  • American Academy of Neurology. Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. National Guidline Clearinghouse
  • 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
  • Abraham A, Albulaihe H, Alabdali M, et al. Elevated vibration perception thresholds in CIDP patients indicate more severe neuropathy and lower treatment response rates. PLoS One. 2015;10(11):e0139689. PMID 26545096
  • Lefaucheur JP, Wahab A, Plante-Bordeneuve V, et al. Diagnosis of small fiber neuropathy: A comparative study of five neurophysiological tests. Neurophysiol Clin. Dec 2015;45(6):445-455. PMID 26596193
  • Azzopardi K, Gatt A, Chockalingam N, et al. Hidden dangers revealed by misdiagnosed diabetic neuropathy: A comparison of simple clinical tests for the screening of vibration perception threshold at primary care level. Prim Care Diabetes. Apr 2018;12(2):111-115. PMID 29029862
  • Goel A, Shivaprasad C, Kolly A, et al. Comparison of electrochemical skin conductance and vibration perception threshold measurement in the detection of early diabetic neuropathy. PLoS One. Sep 2017;12(9):e0183973. PMID 28880907
  • Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) for sensory Nerve Conduction Threshold Tests (sNCTs) (160.23). 2004;
  • Papanas N, Pafili K, Demetriou M, et al. The Diagnostic Utility of VibraTip for Distal Symmetrical Polyneuropathy in Type 2 Diabetes Mellitus. Diabetes Ther. Jan 2020; 11(1): 341-346. PMID 31782049


Policy History:

  • March 2021 - Annual Review, Policy Renewed
  • March 2020 - Annual Review, Policy Revised
  • March 2019 - Annual Review, Policy Renewed
  • March 2018 - Annual Review, Policy Renewed
  • March 2017 - Annual Review, Policy Renewed
  • 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.


*CPT® is a registered trademark of the American Medical Association.