Criteria
Policy Application
All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date.
Vestibular function testing using ENG and VNG testing batteries, caloric testing, or rotational chair testing may be considered
medically necessary
when
ALL
the following conditions have been met:
-
The individual has symptoms of a vestibular disorder (e.g., dizziness, vertigo, imbalance);
and
- A clinical evaluation, including maneuvers such as the Dix-Hallpike test if indicated, has failed to identify the cause of the symptoms.
Vestibular function testing for the assessment of typical benign paroxysmal positional vertigo that can be diagnosed clinically is
not medically necessary
.
Repeat vestibular function testing when treatment resolves symptoms is considered
not medically necessary
.
Vestibular function testing not meeting the criteria as indicated in this policy is considered not medically necessary
.
Procedure Codes
| 92537 | 92538 | 92540 | 92541 | 92542 | 92544 | 92545 |
| 92546 | 92547 | 92700 |
