Article - Billing and Coding: Autonomic Function Tests (A54954)

CMS National Coverage PolicySocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35395, Autonomic Function Tests. Please refer to the LCD for reasonable and necessary requirements.According to a report from Casellini et al (2013), use of an apparatus for testing electrochemical skin conductance (ESC) that "consist of two sets of large-area stainless steel electrodes for the hands and feet that are connected to a computer for recording and data-management purposes. The electrodes are alternately used as an anode or cathode, and a direct current incremental voltage of less than or equal to 4 V is applied to the anode. Through reverse iontophoresis, the device generates voltage to the cathode and a current (intensity of around 0.2 mA) between the anode and cathode proportional to chloride concentration. At low voltages (less than 10 V), the stratum corneum is electrically insulating, and only sweat-gland ducts are conductive [in theory]." The report continues saying the (ESC) "expressed in microSiemens (S), is the ratio between the current generated and the constant DC stimulus (less than or equal to 4 V) applied to the electrodes. . . During the test, patients were required to place their hands and feet on the electrodes and to stand still for 23 min. The device produces ESC results for individual right and left hands and feet. It then calculates an average score between right and left hands and feet. All the ESC results [presented in this study] correspond to the average ESC between right and left sides for both hands and feet. . . Neither special subject preparation nor specially trained medical personnel are required."Coding GuicanceNotice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.Sudoscan and similar devices, by definition, do not meet the description of Current Procedural Terminology (CPT) code 95923 in that the subject preparation, environmental requirements, and specially trained medical personnel requirements are not met. Therefore, to bill this type of testing report the unlisted neurological diagnostic CPT code 95999.When submitting claims to Novitas for Sudoscan and similar devices as described above, providers should report CPT code 95999. The word SUDOSCAN or the term ESC (electrochemical skin conductance) must be noted in the narrative/remarks field (Item 19) on the CMS-1500 claim form or the electronic equivalent.Cardiovagal innervation testing should be reported with CPT code 95921.Vasomotor adrenergic innervation testing should be reported with CPT code 95922.Sudomotor function testing should be reported with CPT code 95923.CPT code 95924 represents combined parasympathetic and sympathetic adrenergic function testing.Consistent with CPT direction, CPT code 95924 should not be reported with CPT codes 95921 or 95922.Providers should refer to the current year CPT manual for assistance with the proper reporting for autonomic function testing.