Dynamic Posturography

POLICY NUMBER

A.2.01.02

DESCRIPTION

Dynamic posturography tests an individual's balance control in situations intended to isolate factors that affect balance in everyday experiences. Posturography provides quantitative information on the degree of imbalance present but is not intended to diagnose specific types of balance disorders.

Balance Disorders

Complaints of imbalance are common in older adults and contribute to the risk of falling in this population. Falls are an important 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. Balance is also 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 can be difficult. Commonly used balance function tests (eg, electronystagmography, rotational chair tests) attempt to measure the extent and site of a vestibular lesion, but do not assess the functional ability to maintain balance.

Role in DiagnosisDynamic posturography aims to provide quantitative information on a patient's 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 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, the platform is fixed or sway-referenced, and whether the visual surround is fixed or sway-referenced. Sway-referencing involves making instantaneous computer-aided alterations to 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 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.

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. Use of foam pads eliminates the sensory and proprioceptive cues. Therefore, the only vestibular input is available when standing on a foam pad with eyes closed.

The NeuroCom EquiTest® (NeuroCom International, Portland, OR; now Clackamas, OR), a dynamic posturography device, was cleared for marketing by the U.S. Food and Drug Administration through the 510(k) process. Other dynamic posturography device makers include Vestibular Technologies (Cheyenne, WY) and Medicapteurs (Balma, France). Companies that previously manufactured dynamic posturography devices include Metitur (Jyvaskyla, Finland) and Micromedical Technology (Chatham, IL).

POLICY

Dynamic posturography is considered investigational.

POLICY EXCEPTIONS

Federal 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 GUIDELINES

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

Investigative 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.

POLICY HISTORY

9/1994: 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.

02/02/2015: Policy reviewed; description updated. Policy statement unchanged.

07/20/2015: Code Reference section updated for ICD-10.

03/29/2016: Policy description updated. Policy statement unchanged. Investigative definition updated in policy guidelines section.

06/01/2016: Policy number A.2.01.02 added.

03/08/2017: Policy description updated regarding devices. Policy statement unchanged.

02/26/2018: Policy description updated regarding devices. Policy statement unchanged.

03/19/2019: Policy reviewed; no changes.

12/19/2019: Code Reference section updated to add new CPT code 92549. Revised code description for CPT code 92548. Effective 01/01/2020.

03/06/2020: Policy reviewed; no changes.

04/06/2022: Policy reviewed; no changes.

03/13/2023: Policy reviewed; no changes.

03/08/2024: Policy reviewed; no changes.

04/09/2025: Policy description updated. Policy statement unchanged.

SOURCE(S)

Blue Cross Blue Shield Association policy # 2.01.02

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

Investigational Codes

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