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DESCRIPTIONComplaints of imbalance are common in older individuals and contribute to the risk of falling in the elderly population. Falls are the most common cause of death and disability in this population in the United States. Maintenance of balance is a complex physiologic process requiring interaction of the vestibular, visual, proprioceptive/somatosensory system, and central reflex mechanisms and is influenced by the general health of the patient (i.e., muscle tone, strength, and range of motion). Therefore, identifying and treating the underlying balance disorder may be difficult. Commonly used balance function tests such electronystagmography (ENG) and rotational chair tests attempt to measure the extent and site of a vestibular lesion, but do not attempt to assess the functional ability of the patient to maintain balance. Posturography tests a patient’s balance control in situations intended to isolate factors that affect balance in everyday experiences. Balance can be rapidly assessed qualitatively by asking the patient to maintain a steady stance on a flat or compressible surface (i.e., foam pads) with the eyes open or closed. By closing the eyes, the visual input into balance is eliminated. The use of foam pads eliminates the sensory and proprioceptive cues. Therefore, only vestibular input is available when standing on a foam pad with eyes closed.
Dynamic posturography attempts to provide more quantitative information regarding the functional ability to maintain balance. 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. The NeurCom EquiTest is a dynamic posturography device approved by the U.S. Food and Drug Administration (FDA). Using this device, the patient undergoes 6 different testing situations designed to evaluate the vestibular, visual, and proprioceptive/somatosensory components of balance. In general terms, the test measures an individual’s balance (as measured by a force platform to calculate the movement of the patient’s center of mass) while visual and somatosensory cues are altered. These tests vary by whether the eyes are open or closed, whether the platform is fixed or sway-referenced, and whether the visual surround is fixed or sway-referenced. Sway-referencing involves making instantaneous computer-aided alteration in the platform or visual surround to coincide with changes in body position produced by sway. The purpose of sway-referencing is to cancel out accurate feedback from somatosensory or visual systems that are normally involved in maintaining balance. In the first 3 components of the test, the support surface is stable, and visual cues are either present, absent, or sway-referenced. In tests 4 to 6, the support surface is sway-referenced to the individual, and visual cues are either present, absent, or sway-referenced. In tests 5 and 6, the only accurate sensory cues that are available for balance are vestibular cues. Results of computerized dynamic 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 be used to localize the site of a lesion.
Other dynamic posturography device makers include Micromedical Technology, Metitur, and Vestibular Technologies.
POLICYDynamic posturography is considered investigational.
POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY9/1994: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Reviewed by MPAC; investigational status maintained
2/11/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
5/28/2002: Code Reference section completed
9/20/2002: Policy reviewed, Sources updated
4/19/2004: Policy reviewed, Description and Policy sections revised to be consistent with BCBSA policy # 2.01.02, Policy section investigational "for assessing balance disorders" deleted
8/4/2005: Code Reference section reviewed, no changes
5/9/2008: Policy reviewed, policy changed from investigational to not medically necessary.
04/13/2010: Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.
12/28/2010: Policy statement changed from not medically necessary to investigational.
01/17/2012: Policy reviewed; no changes.
03/13/2013: Policy reviewed; no changes.
03/05/2014: Policy reviewed; no changes.
SOURCE(S)Blue Cross Blue Shield Association policy # 2.01.02
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.