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DESCRIPTIONQuantitative sensory testing (QST) systems are used for the noninvasive assessment and quantification of sensory nerve function in patients with symptoms of or the potential for neurologic damage or disease. Pain conditions evaluated may include diabetic neuropathy and uremic and toxic neuropathies, complex regional pain syndrome, carpal tunnel syndrome, and other nerve entrapment/compression disorders or damage.
Quantitative sensory testing has been investigated for a broad range of clinical applications, including evaluation of peripheral neuropathies, detection of carpal tunnel syndrome, spinal radiculopathy, evaluation of 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 QST 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 sign, and Phalen and Roos test) 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 criterion standard for evaluation of myelinated large fibers is the electromyography nerve conduction study (EMG-NCS). However, the function of smaller myelinated and unmyelinated sensory nerves, which may show pathologic changes before the involvement of the 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 nerve 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. In addition, to get reliable results, examinations need to be standardized with standardized instructions to the patients, and stimuli must be applied in a consistent manner by trained staff. Psychophysical tests have greater inherent variability, making their results more difficult to reproduce.
A number of quantitative sensory testing (QST) devices have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. They include devices for current perception threshold testing (eg, Medi-Dx 7000® Current Perception Threshold; Neuro Diagnostic Associates), pressure-specified sensory testing (eg, NK Pressure-Specified Sensory Device™; NK Biotechnical), vibration testing (eg Vibration Perception Threshold meter; Xilas Medical), and thermal testing (eg, Thermal Sensory Analyzer, TSA and TSA-II; Medoc Corp., Israel).
POLICYQuantitative 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.
POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all devices approved by the FDA may not be considered investigational and thus, these devices may be assessed only on the basis of their medical necessity.
POLICY GUIDELINESInvestigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY8/2001: Approved by Medical Policy Advisory Committee (MPAC)
2/12/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
8/5/2002: Code Reference section revised
3/7/2003: Code Reference section updated
10/14/2004: Code Reference section reviewed, no changes
1/4/2007: Policy updated to include quantitative sensory testing (QST) and pressure-specified sensory testing as investigational. CPT codes 0106T, 0107T, 0108T, 0109T, and 0110T added to the non-covered codes
4/29/2008: Policy reviewed, no changes
04/14/2010: Policy Exception section revised to include FEP language, Source(s) section revised to remove outdated material; Policy Statement unchanged.
10/21/2010: Policy review; no changes.
10/05/2011: Policy description updated. Added vibration perception threshold testing and thermal threshold testing as investigational.
11/28/2012: Policy reviewed; no changes.
12/13/2013: Policy reviewed; no changes.
11/17/2014: Policy reviewed; description updated. Policy statement unchanged.
07/27/2015: Code Reference section updated for ICD-10.
12/21/2015: Policy description updated regarding devices. Policy statement unchanged. Investigative definition updated in policy guidelines section.
SOURCE(S)Blue Cross Blue Shield Association policy # 2.01.39
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.