Local Coverage Determination (LCD): Autonomic Function Tests (L31465) Contractor Name First Coast Service Options, Inc. Document Information LCD ID L31465 Original Effective Date LCD Title For services performed on or after 01/23/2011 Autonomic Function Tests Revision Effective Date AMA CPT/ADA CDT Copyright Statement For services performed on or after 03/24/2014 CPT only copyright 2002-2013 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Revision Ending Date Medical Association. Applicable FARS/DFARS Apply to N/A Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data Retirement Date N/A Notice Period Start Date 02/07/2014 contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Notice Period End Date 03/24/2014 Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association. CMS National Coverage Policy Language quoted from CMS National Coverage Determination (NCDs) and coverage provisions in interpretive manuals are italicized throughout the Local Coverage Determination (LCD). NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act. Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: CMS Manual System, Pub. 100-02, Medicare Benefit Policy, Chapter 15, Section 80. Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity The autonomic nervous system (ANS) is a regulatory branch of both the central and peripheral nervous system, which controls and regulates the autonomic functions within the body through sympathetic and parasympathetic nerves. These functions include regulation of blood pressure, heart rate, airway size and airflow to the lungs, digestive tract functions, sweat production, bladder control, and sexual function. The ANS acts through a balance of its own two components, the sympathetic and parasympathetic nervous systems. Autonomic failure consists of impaired or absent function of autonomic responses, which may be sympathetic or parasympathetic or both and can involve specific organ systems or can be generalized. There are other autonomic disorders that consist of excessive function of autonomic responses. The concept of an imbalance between opposing autonomic systems is applicable to some disorders, such as some cardiac arrhythmias, but not in all autonomic disorders. Autonomic disorders may be congenital or acquired – primary or secondary. If it becomes unbalanced, a person may experience a variety of symptoms that are sometimes vague and can affect many bodily functions. To the specialist, the presentation of autonomic dysfunction can be specific and diagnosed with simple clinical tests. Autonomic testing, properly performed and interpreted, is helpful toward achieving diagnostic specificity. Autonomic failure is associated with increased morbidity and mortality. Orthostatic hypotension is associated with an increased risk of falls and impairment in activities of daily living. ANS testing can be grouped into the following general catagories: 1. Cardiovagal innervation (CPT code 95921) – a test that provides a standardized quantitative evaluation of vagal innervation to parasympathetic function of the heart. Responses are based on the interpretation of changes in continuous heart recordings in response to standardized maneuvers and include heart rate response to deep breathing, Valsalva ratio, and 30:15 ratio heart rate responses to standing. 2. Vasomotor adrenergic innervation (CPT code 95922) – evaluates adrenergic innervation of the circulation and of the heart in autonomic failure. The following tests are included: beat-to-beat blood pressure and R-R interval response to Valsalva maneuver, sustained hand grip, and blood pressure and heart rate responses to tilt-up or active standing. 3. Sudomotor (CPT code 95923) – function testing is used to evaluate and document neuropathic disturbances that may be associated with pain. The quantitative sudomotor axon reflex test (QSART), thermoregulatory sweat test (TST), sympathetic skin responses, and silastic sweat imprints are tests of sympathetic cholinergic sudomotor function. The QSART measures axon reflex-mediated sudomotor responses quantitatively and evaluates post-ganglionic sudomotor function. Recording is usually carried out from the forearm and three lower extremity skin sites to assess the distribution of post-ganglionic deficits. The TST evaluates the distribution of sweating by a change in color ofan indicator powder. This test has a high sensitivity, and its specificity for delineating the site of lesion is greatly enhanced when used in conjunction with QSART. Sweat imprints are formed by the secretion of active sweat glands into a plastic (silastic) imprint. The test can determine sweat gland density, a histogram of sweat droplet size and sweat volume per area. 4. Combined cardiovagal and vasomotor adrenergic innervation testing (CPT code 95924) of the autonomic nervous system is specifically of parasympathetic function and vasomotor adrenergic function using at least a 5-minute tilt with a passive tilt table. Indications: Appropriate application and interpretation of ANS testing requires a detailed knowledge of the testing criterion and a match between the tests of suspected clinical/functional impairment with the autonomic activity being tested. Most autonomic disorders are diagnosed clinically, with laboratory and formal diagnostic testing when ordered and performed appropriately playing both a primary diagnostic and an adjunctive or confirmatory role. Testing may also be appropriate to monitor disease progression when there is a change in clinical status or to evaluate a patient’s response to specific treatment for an autonomic disorder. Autonomic function testing is covered as reasonable and necessary when used as a diagnostic tool to evaluate symptoms indicative of vasomotor instability, such as hypotension, orthostatic tachycardia, and hyperhidrosis after more common causes have been excluded by other testing, and the ANS testing is directed at establishing a more accurate or definitive diagnosis or contributing to clinically useful and relevant medical decision making for one of the following indications: 1. To diagnose the presence of autonomic neuropathy in a patient with signs or symptoms suggesting a progressive autonomic neuropathy. 2. To evaluate the severity and distribution of a diagnosed progressive autonomic neuropathy. 3. To differentiate the diagnosis between certain complicated variants of syncope from other causes of loss of consciousness. 4. To evaluate inadequate response to beta blockade in vasodepressor syncope. 5. To evaluate distressing symptoms in a patient with a clinical picture suspicious for distal small fiber neuropathy in order to diagnose the condition. 6. To differentiate the cause of postural tachycardia syndrome. 7. To evaluate change in type, distribution, or severity of autonomic deficits in patients with autonomic failure. 8. To evaluate the response to treatment in patients with autonomic failure who demonstrate a change in clinical exam. 9. To diagnose axonal neuropathy or suspected autonomic neuropathy in the symptomatic patient. 10. To evaluate and treat patients with recurrent unexplained syncope to demonstrate autonomic failure, after more common causes have been excluded by other standard testing. Equipment for Autonomic Nervous System Studies General professional standards apply for all equipment. Unknown algorithms untested on the Medicare population in systematic trials do not constitute the professional component of diagnostic testing. Equipment with FDA clearance for heart rate variability measurements in response to paced respirations and exercises that tests only heart rate variability does not meet the full range of testing parameters required for the performance of 95921 and 95922 and does not ensure full test requirements, such as blood pressure monitoring, nor do they incorporate proper testing conditions, such as the use of a tilt table. Providers may be asked to supply information on the equipment used to perform autonomic nervous system studies to ensure that all studies performed meet the requirements of the procedure. Limitations: Syndromes of autonomic dysfunction for which ANS testing might add valuable clinical information are relatively rare. Generally, only after excluding more common causes of autonomic signs or symptoms (e.g., hypotension, hyperhidrosis, and orthostatic tachycardia) may formal autonomic testing be indicated to exclude or confirm autonomic disorders. The following indications are not considered medically reasonable and necessary and will not be covered: To screen patients without signs or symptoms of autonomic dysfunction, including patients with diabetes, hepatic, or renal disease; Testing for the sole purpose of monitoring disease intensity or treatment efficacy in diabetes, hepatic, or renal disease; Testing where the results are not used in clinical decision-making and patient management; Testing performed by physicians who do not have evidence of training and expertise to perform and interpret these tests. Testing must be done for an accepted clinical indication by a properly trained examiner and interpreted by qualified individuals within their scope of practice (weekend courses may not demonstrate expertise). Physicians must have knowledge, training, and expertise to perform and interpret these tests, and to assess and train personnel working with them. This training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program or must reflect extensive continued medical education activities. If these skills have been acquired by way of continued medical education, the courses must be comprehensive and designated for the American Medical Association (AMA) category I credit by an ACCME (Accreditation Council for Continuing Medical Education) or SMS (State Medical Society) accredited CME provider. CPT code 95943, for example Ansar (ANX 3.0), is not medically reasonable and necessary since it is not proven that this type of testing is at least as beneficial as existing and available medically appropriate testing alternatives. The clinical validity and clinical utility of these technologies have not been established. The qualifications of the personnel performing the testing are not standardized. If a physician finds that this non-standardized component information of autonomic function testing is useful in a patient assessment and clinical decision making given certain patient risks/signs/symptoms, this would be included in the physician’s basic evaluation and management service and not separately covered. When patients have significant symptoms, the primary physician should consider referring to the appropriate specialist or subspecialist for testing. false Coding Information Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 012x Hospital Inpatient (Medicare Part B only) 013x Hospital Outpatient 071x Clinic - Rural Health 085x Critical Access Hospital Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. 092X Other Diagnostic Services - General Classification CPT/HCPCS Codes Group 1 Paragraph: N/A Group 1 Codes: TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; CARDIOVAGAL INNERVATION (PARASYMPATHETIC FUNCTION), INCLUDING 2 OR MORE OF THE FOLLOWING: HEART RATE 95921 RESPONSE TO DEEP BREATHING WITH RECORDED R-R INTERVAL, VALSALVA RATIO, AND 30:15 RATIO TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; VASOMOTOR ADRENERGIC INNERVATION (SYMPATHETIC ADRENERGIC FUNCTION), INCLUDING BEAT-TO-BEAT BLOOD 95922 PRESSURE AND R-R INTERVAL CHANGES DURING VALSALVA MANEUVER AND AT LEAST 5 MINUTES OF PASSIVE TILT TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; SUDOMOTOR, INCLUDING 1 OR MORE OF 95923 THE FOLLOWING: QUANTITATIVE SUDOMOTOR AXON REFLEX TEST (QSART), SILASTIC SWEAT IMPRINT, THERMOREGULATORY SWEAT TEST, AND CHANGES IN SYMPATHETIC SKIN POTENTIAL TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; COMBINED PARASYMPATHETIC AND 95924 SYMPATHETIC ADRENERGIC FUNCTION TESTING WITH AT LEAST 5 MINUTES OF PASSIVE TILT ICD-9 Codes that Support Medical Necessity Group 1 Paragraph: N/A Group 1 Codes: 250.60 - DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS 250.63 UNCONTROLLED - DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED 277.30 AMYLOIDOSIS, UNSPECIFIED - OTHER AMYLOIDOSIS 277.39 333.0 OTHER DEGENERATIVE DISEASES OF THE BASAL GANGLIA 337.00 IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY, UNSPECIFIED 337.09 OTHER IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY 337.20 - REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED - REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED 337.29 SITE 356.4 IDIOPATHIC PROGRESSIVE POLYNEUROPATHY 356.8 OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY 356.9 UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY 458.0 ORTHOSTATIC HYPOTENSION 780.2 SYNCOPE AND COLLAPSE 780.8 GENERALIZED HYPERHIDROSIS 785.0 TACHYCARDIA UNSPECIFIED ICD-9 Codes that DO NOT Support Medical Necessity N/A false General Information Associated Information Documentation Requirements General professional standards with FDA clearance apply for all equipment used in ANS testing. Providers may be asked to supply information on the equipment used to perform ANS studies to ensure all studies performed meet the requirements of the procedure. Medical record documentation maintained by the performing provider must clearly support the medical necessity for ANS testing as well as the test reports and interpretation. Supportive documentation showing medically reasonable and necessary indications as outlined in this LCD are expected to be documented in the medical record and be available upon request. This documentation includes, but is not limited to, relevant medical history, physical examination, results of pertinent diagnostic tests or procedures, and after more common causes of autonomic signs or symptoms have been excluded (see limitations section of LCD). The CMS Manual System, Pub. 100-08, Program Integrity Manual, Chapter 13, Section 5.1 (http://www.cms.hhs.gov/manuals/downloads/pim83c13.pdf outlines that “reasonable and necessary" services are "ordered and/or furnished by qualified personnel." A qualified physician for this service/procedure is defined as follows: A) Physician is properly enrolled in Medicare. B) Training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty in the United States or must reflect equivalent education, training, and expertise endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States. If the provider of the ANS studies is other than the ordering/referring physician/nonphysician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies. Utilization Guidelines Diagnostic testing may be allowed once to confirm or exclude specific autonomic disease. For patients with diagnosed autonomic disorders, repeat testing is governed by a change in clinical status or response to a therapeutic intervention. If a repeat test is needed, it is not expected to exceed once per year. Providers who perform these tests on an unusually high proportion of their patients, or at frequencies exceeding once per year may be subject to medical review. Sources of Information and Basis for Decision Aetna Clinical Policy Bulletin # 0485: Autonomic Testing/Sudomotor Tests, 2013. Aker, K. (2008). Complex regional pain syndrome: A review of diagnostic tools. Reflex Sympathetic Dystrophy Syndrome Association. Retrieved August 4, 2010, from http://www.rsds.org/4/resources/CRPS_Diagnosis.htm. American Academy of Neurology. (2010). Complex regional pain syndrome. Retrieved August 19, 2010, from http://patients.aan.com/disorders/index.cfm?event=view&disorder_id=894 American Heart Association. Autonomic Nervous System. 2010. Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. April 2005; 28(4):956-962. CGS Administrators, LLC. LCD (L33249) Nervous System Studies – Autonomic Function, Nerve Conduction and Electromyography, 2013. CPT Changes: An Insider’s View 2013. Current Procedural Terminology (CPT) Assistant 2002 – 2008. England, J., Gronseth, G., Franklin, F., Carter, G., Kinsella, L., Cohen, J. et al. (2009). Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Neurology 72:177184. Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab. 2005 Oct;90(10):5896-5903. Mayo Foundation for Medical Education and Research. (2001-2010). Amyloidosis. Retrieved August 19, 2010 at http://www.mayoclinic.org/amyloidosis/ Neuroscience/Neurology Services – Greenwich hospital. Autonomic Function Laboratory, 2000-2010. Retrieved July 21, 2010, from http://www.greenhosp.org/medicalservices_neuroscience_autonomic.asp Tesfaye S, Boulton AJ, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes CareOct. 2010; 33(10):2285-2293.] The Merck Manual for Healthcare Professionals. Autonomic Nervous System. The Merck Manuals online library, 2009. Retrieved July 21, 2010, from http://www.merck.com/mmpe/print/sec16/ch208/ch208a.html UPMC Health Plan, Policy and Procedure Manual. Autonomic Nervous System Testing, 2009. U.S. Food and Drug Administration (2012). Inspections, Compliance, Enforcement, and Criminal Investigations. Retrieved at http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2012/ucm327893.htm Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003; 26: 1553-1579.] Wang, A., Fealey, R., Gehrking, T., & Low, P. (2008). Patterns of neuropathy and autonomic failure in patients with amyloidosis. Mayo Clinic Proceedings, 83, (11), 1226-1230. false Revision History Information Please note: The Revision History information included in this LCD prior to 1/24/2013 will now display with a Revision History Number of "R1" at the bottom of this table. All new Revision History information entries completed on or after 1/24/2013 will display as a row in the Revision History section of the LCD and numbering will begin with "R2". Revision Revision Reason(s) for History Revision History Explanation History Date Change Number 03/24/2014 R2 Revision Number: 3 Publication: February 2014 Connection Provider Education/Guidance LCR A2014-019 Explanation of Revision: Major revisions were made throughout the entire LCD. The effective date of this revision is based on date of service. 01/01/2013 R1 Revision Number:2 Start Date of Comment Period:N/A Start Date of Notice Period:01/01/2013 HCPCS Addition/Deletion Original Effective Date:01/01/2013 HCPCS/ICD9 Descriptor Change LCR A2013-020 December 2012 Connection Explanation of revision: Annual 2013 HCPCS Update. CPT codes 95924 and 95943 Narrative Change and descriptors were added to the “CPT/HCPCS Codes” section. The effective date of this revision is based on date of service. Revision Number:1 Start Date of Comment Period:N/A Start Date of Notice Period:07/01/2011 Revised Effective Date:06/14/2011 LCR A2011-062 June 2011 Connection Explanation of Revision: Based on an outside request to clarify our current training statement outlined in this LCD, language under the “Documentation Requirements” section of the LCD has been deleted and replaced with a revised statement regarding the qualification and training. Revisions will be effective based on process date. Revision Number:Original Start Date of Comment Period:09/30/2010 Start Date of Notice Period:12/09/2010 Original Effective Date: 01/23/2011 LCR A2010-063 December 2010 Bulletin 11/25/2012 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document: 95921 descriptor was changed in Group 1 95922 descriptor was changed in Group 1 95923 descriptor was changed in Group 1 false Associated Documents Attachments Coding guidelines effec 3/24/14 (PDF - 56 KB ) Comment Summary 10/10/13-11/23/13 (a comment and response document) (PDF - 88 KB ) Related Local Coverage Documents N/A Related National Coverage Documents N/A Public Version(s) Updated on 01/31/2014 with effective dates 03/24/2014 - N/A Updated on 12/19/2012 with effective dates 01/01/2013 - 03/23/2014 Some older versions have been archived. Please visit the MCD Archive Site to retrieve them. Coding Guidelines Autonomic Function Tests Part A Form Date: 09/18/09 Page 1 of 2 1-3.2.41 MP Part B FL Draft LCD FIRST COAST SERVICE OPTIONS CODING GUIDELINES LCD Database ID Number L31465 Contractor Name First Coast Service Options, Inc. Contractor Number 09101 - Florida 09201 – PR/USVI LCD Title Autonomic Function Tests Coding Guidelines The requirement for CPT code 95921 Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio] is that at least two of the tests should be performed in order to bill this code. If only one test is performed, modifier ‘52’ should be appended to indicate that a reduced service was provided. The requirement for CPT code 95922 Testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least five minutes of passive tilt] is that both a passive tilt and the Valsalva maneuver be performed. If only one of the components is performed, then modifier 52, reduced services, should be appended to code 95922. CPT code 95924 should be reported only when both the parasympathetic function and vasomotor adrenergic function are tested together with at least 5 minutes of passive tilt. Definitions of the terms included in code descriptors: Valsalva maneuver: Any forced expiratory effort (strain) against a closed airway, whether at the nose and mouth or at the glottis. This causes high intrathoracic pressure that impedes venous return to the right atrium and, therefore, can be used to study cardiovascular effects of raised peripheral venous pressure and decreased cardiac filling and cardiac output, as well as, post strain responses. Valsalva ratio: The maximum heart rate divided by the lowest heart rate. The subject performs a standardized Valsalva maneuver, and the derived heart rate is analyzed. Quantitative sudomotor axon reflex test (QSART): An evaluation that uses a quantitative noninvasive method to determine the integrity of the distal postganglionic sympathetic nerve fibers in diabetic and other neuropathies affecting autonomic nerves and in the progressive autonomic disorders. It uses the stimulation of sympathetic nerve fibers to the sweat glands at standard sites. The test is done optimally on one forearm site and three lower extremity sites in order to determine the severity and distribution of the sympathetic deficit. Coding Guidelines Autonomic Function Tests Part A Form Date: 09/18/09 Page 2 of 2 1-3.2.41 MP Part B FL Draft LCD Revision History Date 03/24/2014 01/01/2013 01/23/2011 Revision 2- Removed reference to CPT code 95943 and revised language to CPT code 95924. The effective date of this revision is based on date of service. 1-Annual 2013 HCPCS Update. Added CPT code 95924 and 95943 with instructions. The effective date of this revision is based on date of service. Original Local Coverage Article: Autonomic function tests revision to the Part A LCD (A52786) false Contractor Information Contractor Information Table Contractor Name First Coast Service Options, Inc. false Article Information General Information General Article Information Table Article ID A52786 Original Effective Date Article Title 02/07/2014 Autonomic function tests revision to the Part A LCD Revision Effective Date AMA CPT / ADA CDT Copyright Statement N/A CPT only copyright 2002-2013 American Medical Association. All Rights Reserved. CPT is a registered Revision Ending Date trademark of the American Medical Association. N/A Applicable FARS/DFARS Apply to Government Use. Retirement Date Fee schedules, relative value units, conversion N/A factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association. Article Guidance Article Text: LCD ID number: L31465 (Florida/Puerto Rico/U.S. Virgin Islands) Current Procedural Terminology® (CPT®) code 95943 was new for calendar year 2013 and at that time was added to the autonomic function tests (AFT) local coverage determination (LCD) as a result of the Annual 2013 Healthcare Common Procedure Coding System (HCPCS) Update. It is described as an autonomic function test for simultaneous, independent, quantitative measures of both parasympathetic and sympathetic function. It was created to report when an autonomic function testing does not include beat-to-beat recording, or when testing without the use of a tilt table. It was determined that the clinical validity and clinical utility of these technologies have not been established and the qualifications of the personnel performing the testing are not standardized. Therefore, CPT® code 95943 is being removed from the “ CPT®/HCPCS codes” section of the LCD, and language is being added to the “Limitations” section of the LCD and the Coding Guidelines attachment indicating it does not meet the medically reasonable and necessary threshold for coverage. Additionally, CPT® code 95924 (AFT with passive tilt testing), also new for calendar year 2013, was also added to the AFT LCD during the Annual 2013 HCPCS Update; however, the LCD does not specifically address this code. Therefore, the LCD has been revised to include limited indications for this testing. Effective date This LCD revision is effective for services rendered on or after March 24, 2014. First Coast Service Options, Inc. LCDs are available through the CMS Medicare coverage database at http://www.cms.gov/medicarecoverage-database/overview-and-quick-search.aspx external.gif. Coding Guidelines for an LCD (when present) may be found by selecting “LCD Attachments” in the “Jump to Section…” drop-down menu at the top of the LCD page. false Coding Information Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims. N/A Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the article services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. N/A CPT/HCPCS Codes N/A Covered ICD-9 Codes N/A Non-Covered ICD-9 Codes N/A false Revision History Information N/A false Associated Documents Related Local Coverage Document(s) N/A Related National Coverage Document(s) N/A Statutory Requirements URL(s) N/A Rules and Regulations URL(s) N/A CMS Manual Explanations URL(s) N/A Other URL(s) N/A Public Version(s) Updated on 01/31/2014 with effective dates 02/07/2014 - N/A