Appeal type: Practitioner Services
Decision: Unfavorable

We decided that the Plan does not have to pre-approve motion analysis (96000) and computerized dynamic posturography (92548).
You asked the Plan to pre-approve motion analysis (96000) and computerized dynamic posturography (92548). You say that the requested motion analysis and computerized dynamic posturography are medically necessary. The Plan denied your request. The Plan says the requested motion analysis and computerized dynamic posturography are not medically necessary.
The Plan must follow Medicare rules. Medicare rules say that items and services that are not medically necessary are not covered. We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to determine if the Plan was correct in denying the request to pre-approve motion analysis (96000) and computerized dynamic posturography (92548). Our reviewer says that the requested motion analysis and computerized dynamic posturography are not medically necessary. Our physician reviewer found there is insufficient evidence in the published, peer-reviewed scientific literature that supports the use of gait analysis for the evaluation of the enrollee's non-specific complaints of dizziness/vertigo. The primary condition for which there is a body of evidence to support the use of gait analysis is in cerebral palsy (which is not applicable to this case). The proposed testing/evaluation has not readily been shown to be of clinical utility in the diagnosis/management of patients with dizziness. In as much the use of this technology would not be appropriate for the enrollee's specific condition. Nor would performance of said testing otherwise be consistent with standards of practice/care. In as much it would not be medically necessary. The evidence within published peer-reviewed medical literature on the safety and effectiveness of computerized dynamic posturography (CDP) largely consists of older studies, some of which were poorly designed, with varying results that were conflicting in nature. Most of these studies had marked methodological limitations including but not limited to small sample sizes, non-randomization, inadequate follow-up and poor design which have prohibited the generalizability of published study results. In addition, of those studies that reported a positive outcome--there have not been any well-designed studies conducted to validate the results of
the preliminary studies. Furthermore, the data from published studies have failed to demonstrate any beneficial effects of CDP evaluation on patient outcomes and management. Given all of these limitations, particularly the need for further study of the technology to determine if it has any benefit on outcomes and utility in practice, this service would be investigational--and therefore not eligible for coverage. We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that Medicare rules for coverage of motion analysis (96000) and computerized dynamic posturography (92548) have not been met. Therefore, we decided that the Plan does not have to pre-approve motion analysis (96000) and computerized dynamic posturography (92548).