Appeal type: Experimental/Investigational
Decision: Overturned

Diagnosis: Dizziness.

Treatment: Code 92548- Computerized dynamic posturography sensory organization test (CPD-SOT), 6 Conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation report.

The insurer denied coverage for  code 92548- Computerized dynamic posturography sensory organization test (CPD-SOT), 6 Conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation report.

The denial is upheld. 

This is a female patient diagnosed with obstructive sleep apnea, atrial fibrillation, arthritis, cataract, Crohn's disease, end-stage liver disease, gastroesophageal reflux disease (GERD), hyperlipidemia, hypertension, hypothyroidism, migraine, and unspecified amblyopia. According to an evaluation, the patient presented with complaints of vertigo spells. The patient carried an outside diagnosis of vestibular migraines. Dizziness was accompanied by left ear aural fullness, pulsatile tinnitus in the right ear, and loudness intolerance. The dizziness lasted for a few days. Between episodes of dizziness, the patient reported feeling normal and had no associated symptoms. 

As per literature review, there is insufficient data to determine if computerized dynamic posturography (CDP) is more beneficial than any of the standard testing procedures. A single center, retrospective review was conducted by Morisod et al. (2018) to look for a specific posturographic pattern among patients diagnosed with chronic subjective dizziness (CSD) and to visualize improvement after vestibular rehabilitation. The study included 114 patients who underwent CDP. Sixty-two percent of the assessment posturographies were abnormal. The most affected sub-items were limit of stability and composite score of sensory organization tests. In the 42 patients who had vestibular rehabilitation and a post rehabilitation posturography, the proportion of abnormal posturography significantly dropped from 79% to 33%. The authors concluded that patients with CSD have a high rate of abnormal posturography, but without a specific pattern. The findings of this study need to be validated by well-designed studies.

Overall, there is weak evidence in the peer-reviewed literature regarding the efficacy of computerized dynamic posturography (CDP) for evaluating vestibular and other disorders. There is a lack of well-designed, randomized controlled trials (RCTs) with blinded assessments to demonstrate the diagnostic utility of CDP compared with standard tests. Furthermore, there is insufficient evidence demonstrating consistent and beneficial effects of CDP testing on patient-relevant outcomes. CDP (code 92548) is approved by the Food and Drug Administration (FDA) for evaluation of dizziness and malingering. However, there is not enough data on this testing device to determine who is a good candidate. This requested test is not a treatment, but a form of testing to attempt to determine the source of a patient's disequilibrium.   

The code 92548- Computerized dynamic posturography sensory organization test (CPD-SOT), 6 Conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation report is not likely to be more beneficial than any of the standard treatments/procedures for this patient.

The carrier's denial of code 92548- Computerized dynamic posturography sensory organization test (CPD-SOT), 6 Conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform, and visual sway), including interpretation report should be upheld.