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Decision: unknown

 
The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that Syndromes of autonomic dysfunction which require formal autonomic function testing are 
relatively rare. Generally, only after excluding more common causes of autonomic signs or symptoms (e.g., 
hypotension, hyperhidrosis, and orthostatic tachycardia) may formal autonomic testing be indicated to exclude 
or confirm rarer autonomic disorders. Autonomic function testing is covered as reasonable and necessary when 
used as a diagnostic tool to evaluate symptoms indicative of vasomotor instability and the autonomic nervous 
system (ANS)  testing is directed at establishing a more accurate or definitive diagnosis or contributing to 
clinically useful and relevant medical decision making for one of the following indications: 
 
    To diagnose the presence of autonomic neuropathy in a patient with signs or symptoms suggesting a 
progressive autonomic neuropathy. 
    To evaluate the severity and distribution of a diagnosed progressive autonomic neuropathy. 
    To differentiate the diagnosis between certain complicated variants of syncope from other causes of loss of 
consciousness. 
    To evaluate inadequate response to beta blockade in vasodepressor syncope. 
    To evaluate distressing symptoms in a patient with a clinical picture suspicious for distal small fiber 
neuropathy in order to diagnose the condition. 
    To differentiate the cause of postural tachycardia syndrome. 
    To evaluate change in type, distribution or severity of autonomic deficits in patients with autonomic failure. 
    To evaluate the response to treatment in patients with autonomic failure who demonstrate a change in 
clinical exam. 
    To diagnose axonal neuropathy or suspected autonomic neuropathy in the symptomatic patient. 
    To evaluate and treat patients with recurrent unexplained syncope or demonstrate autonomic failure, after 
more common causes have been excluded by other standard testing. 
 
The following indications are considered not medically reasonable and necessary and will not be covered: 
     Screening patients without signs or symptoms of autonomic dysfunction, including patients with diabetes, 
hepatic or renal disease. 
    Testing for the sole purpose of monitoring disease intensity or treatment efficacy in diabetes, hepatic or renal 
disease. 
    Testing results that are not used in clinical decision-making or patient management. 
    Testing performed by physicians who do not have evidence of training, and expertise to perform and 
interpret these tests. Physicians must have knowledge, training, and expertise to perform and interpret these 
tests, and to assess and train personnel working with them. This training and expertise must have been acquired 
within the framework of an accredited residency and/or fellowship program or must reflect extensive continued 
medical education activities. If these skills have been acquired by way of continued medical education, the 
courses must be comprehensive, offered, sponsored or endorsed by an academic [institution] in the United 
States and/or by the applicable specialty/subspecialty society in the United States, and designated by the 
American Medical Association (AMA) as category I credit or the American Osteopathic Association (AOA). 
    General professional standards with FDA clearance apply for all equipment used in ANS testing. 
    Testing with ANSAR ANX 3.0 or a similar machine is considered investigational for screening and will not 
be covered. 
 
You can find this information in the Local Coverage Determination (LCD) Autonomic Function Testing 
L36236. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.