What does Medicare consider a valid Computerized Dynamic Posturography (CDP) test?

 

This post falls in the Op-Ed category. It is simply the opinion of the editor (That’s me). Feel free to disagree. I don’t mind.

In the series of vestibular codes, there is CPT Code 92548 – Computerized Dynamic Posturography. In the AMA code descriptor there is no detailed description of how this procedure is performed, or what equipment is required. All we have to go on is what you see above: Computerized-Dynamic-Posturography. First, let’s get out the dictionary (Merriam-Websters) and see exactly what each of these words means:

Computerized – “to carry out, control, or produce by means of a computer”

Dynamic – “Relating to energy or physical force in motion: opposed to static.”

Posturography – There is no entry in Merriam-Websters for posturography, so I will use the entry from Wikipedia (proceed with caution). “Posturography is a general term that covers all the techniques used to quantify postural control in upright stance in either static or dynamic conditions.”

It seems clear that in order to qualify for this code, you must perform some technique to assess postural control (there are many), and it must be assisted by a computer (most commercially available posturography units are computer assisted). The defining term then is the word dynamic, which in this context I interpret as “not static.” It appears that a system in which the platform can be moved through computer control would qualify under this description.

Recently, one of the larger Medicare administrators, Palmetto GBA, issued a new LCD (Local Coverage Determination) for vestibular testing with a detailed description of CDP (92548):

“Computerized dynamic posturography (CDP) is a test of the vestibulospinal system and assesses an individual’s ability to maintain standing balance under a variety of sensory conditions. During this test, the individual stands on two force plates which measure the individual’s postural sway. The dynamic posturography test actually consists of several different subsets of conditions that quantify the patient’s ability to use visual, somatosensory and vestibular cues to maintain standing balance. The motor coordination subtests measure the automatic postural reactions to sudden translational or pitch movements of the support surface. The third subset, the Electromyography (EMG) test, measures the integrity of peripheral and central pathways for motor innervation of the lower limbs as reflected by the onset of motor responses to rotational movements of the support surface. Responses are measured by surface EMG, and related to normal values by age. While the posturography test is a non-localizing test, patterns of performance on the various subtests are helpful in diagnosis of the etiology of vestibular dysfunction. Abnormal findings in the motor control tests or EMG test are indicative of central rather than peripheral vestibular problems. This test is not a simple balance test. “

This is essentially a description of the Neurocom Equitest. This description is so detailed that only the Neurocom top of the line platforms would qualify. I suspect this was written in response to fraudulent use of this code in California around 2007. This language has never been vetted through the AMA CPT process, does not accurately represent CDP as performed in most vestibular specialty clinics, and is contrary to AMA and CMS guidelines, creating a monopoly for a specific manufacturer.  Additionally, aspects of the CDP exam as described here are rarely performed in the clinic setting. Simply, hardly anyone does CDP as described in this LCD. I suggest eliminating the MCT and EMG portions of the description, as there is no evidence to support their routine clinical use, while the SOT portion of the CDP exam has been studied extensively and proven beneficial in treatment planning.

That’s what I think. What do you think?

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About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.