CurrentAetnaPolicy 0390

Smell and Taste Disorders: Diagnosis

Clinical policy governing diagnostic evaluation of unexplained olfactory (smell) and gustatory (taste) dysfunction for Aetna members, including which tests and consultations are considered medically necessary and which are investigational.

Policy Summary

PayerAetna

PolicySmell and Taste Disorders: Diagnosis

Policy CodePolicy 0390

Change TypeNo material change

Effective Date

Next Review Date

Key ActionObtain a complete medical history and physical exam and perform a standardized olfactory test (e.g., UPSIT or Sniffin' Sticks) to establish impairment before further diagnostic work-up.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

13Medically necessary services listed

12Investigational services listed

R43.xICD-10 range

>2MAmericans affected (approx.)

Coverage Criteria for Diagnostic Evaluation

Medically necessary diagnostic services

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Medically necessary diagnostic components: Biopsy of the olfactory mucosa; drug assays and chemical analyses when certain medications or nutritional deficiencies are suspected causes; electroencephalography (EEG) for members with a history of seizures; hematological tests including hematocrit, hemoglobin, white blood cell count, urea nitrogen, creatinine, glucose, erythrocyte sedimentation rate, eosinophil count, and immunoglobulin E; complete medical history and physical examination; nasal endoscopy; neuroimaging with CT or MRI to rule out intra-cranial or peripheral nerve abnormality; neurological, otolaryngological, and psychiatric consultations as indicated; standardized taste tests (e.g., Taste-Threshold Test, Taste-Suprathreshold Test, Taste-Quadrant Test, Flavor Discrimination Test) and standardized olfactory tests (e.g., UPSIT, Sniffin' Sticks, University of Connecticut Test Battery, Pocket Smell Test, Brief Smell Identification Test)

An initial and one follow-up visit for testing are considered medically necessary; additional visits for testing are considered not medically necessary.

Experimental / Investigational (Not covered)

Considered experimental and investigational (not medically necessary) because the peer-reviewed medical literature does not support use for this indication

Investigational tests: Cerebrospinal fluid SARS-CoV-2 antibody testing; electrogustometry; genotyping of the TAS2R38 gene; magnetic resonance imaging specifically for evaluation of COVID-19 olfactory dysfunction; measurement of nasal nitric oxide; olfactometry; olfactory and gustatory event potentials (evoked potentials); positron emission tomography (PET); rhinomanometry; rhinometry (acoustic rhinometry); single photon emission computed tomography (SPECT); tests for Helicobacter pylori infection

These services are considered experimental and investigational for diagnosis of unexplained olfactory or gustatory dysfunction and are not medically necessary.

The policy identifies a set of specific diagnostic tests and procedures that have been evaluated for use in unexplained olfactory and gustatory dysfunction. Services listed as investigational include: cerebrospinal fluid SARS‑CoV‑2 antibody testing; electrogustometry; genotyping of the TAS2R38 gene; magnetic resonance imaging for evaluation of COVID‑19 olfactory dysfunction; measurement of nasal nitric oxide; olfactometry; olfactory and gustatory event potentials; positron emission tomography (PET); rhinomanometry; rhinometry (acoustic rhinometry); single photon emission computed tomography (SPECT); and tests for Helicobacter pylori infection.

Coding and Diagnosis Codes

CPT codes covered if selection criteria are metCPTCovered

30100	Biopsy, intranasal.
31231	Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure).
70450	Computed tomography head or brain; without contrast material.
70460	Computed tomography head or brain; with contrast material(s).
70470	Computed tomography head or brain; without contrast material, followed by contrast material(s) and further sections.
70496	Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing.
70551	Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material.
70552	Magnetic resonance imaging, brain; with contrast material(s).
70553	Magnetic resonance imaging, brain; without contrast material, followed by contrast material(s) and further sequences.
82565	Creatinine; blood.

1–10 of 19

1/2

CPT codes not covered for indications listed in the CPB / investigationalmixedNot Covered

Genotyping of the TAS2R38 gene	No specific CPT code listed.
Cerebrospinal fluid SARS-CoV-2 antibody testing	No specific CPT code listed.
70540	Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material.
70542	Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s).
70543	Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material, followed by contrast material(s) and further sequences.
78267	Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter pylori].
78268	Urea breath test analysis [Helicobacter pylori].
78608	Brain imaging, positron emission tomography (PET); metabolic evaluation.
83013	Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13).
83014	Drug administration.

1–10 of 13

1/2

Other CPT codes related to the CPBCPT

31233	Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture).
31235	Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoid face or cannulation of ostium).
31237	Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or debridement (separate procedure).
80150-80202	Therapeutic drug assays (range 80150-80202 listed).
84630	Zinc.
92511	Nasopharyngoscopy with endoscope (separate procedure).
95816-95819	Electroencephalogram (EEG) including recording awake and drowsy or including awake and asleep (range 95816-95819 listed).

ICD-10 codesICD-10

R43.0-R43.9	Disturbances of smell and taste.
G52.0	Disorders of olfactory nerve [COVID-19 olfactory dysfunction].
U09.9	Post COVID-19 condition, unspecified [COVID-19 olfactory dysfunction].

inv-09: Use of standardized olfactory test before work-up

Required test before diagnostic work-upAdminister a standardized olfactory test (e.g., University of Pennsylvania Smell Identification Test [UPSIT] or University of Connecticut Test Battery) to establish impairment before further diagnostic evaluation.

PurposeDocument objective olfactory dysfunction prior to imaging, biopsy, laboratory assays, or specialist referral.

UPSIT descriptionObjective, quantitative 40-item odor identification test with multiple-choice responses; high internal consistency and correlates with other olfactory tests.

Alternative validated testsUniversity of Connecticut Test Battery or Sniffin' Sticks may be used as validated alternatives for olfactory assessment.

TimingPerform standardized olfactory testing prior to initiating further work-up to confirm the presence and degree of impairment.

Provider Actions, Authorization, and Documentation

Note

Experimental / Investigational Procedures

Procedures and tests listed below are considered experimental/investigational for diagnosis of unexplained olfactory or gustatory dysfunction because peer‑reviewed evidence does not support their use for this indication.

Cerebrospinal fluid SARS-CoV-2 antibody testing
Electrogustometry
Genotyping of the TAS2R38 gene
MRI specifically for COVID-19 olfactory dysfunction
Measurement of nasal nitric oxide levels
Olfactometry
Olfactory and gustatory event potentials
Positron emission tomography (PET)
Rhinomanometry
Rhinometry (acoustic rhinometry)
Single photon emission computed tomography (SPECT)
Tests for Helicobacter pylori infection

Prior Authorization

Prior Authorization and Denial Triggers

There are no explicit prior authorization requirements or specific denial triggers listed in this policy excerpt. Providers should verify coverage with the member's plan and check for any plan‑level authorization rules prior to performing services.

No specific prior authorization requirements listed in this policy excerpt
No explicit denial triggers specified in this excerpt

Documentation Required

Required Clinical Documentation

Required clinical documentation to support medically necessary evaluation of smell and taste disorders includes a complete medical history and physical examination and results of standardized smell/taste testing. Examples of acceptable standardized olfactory tests include the University of Pennsylvania Smell Identification Test (UPSIT) or Sniffin' Sticks. Additional supporting documentation may include relevant laboratory studies, neuroimaging reports, EEG when indicated, and specialty consultation notes.

Complete medical history and physical examination
Standardized olfactory testing (e.g., UPSIT, Sniffin' Sticks, University of Connecticut Test Battery, Pocket Smell Test, Brief Smell Identification Test)
Standard taste testing (e.g., Taste-Threshold, Taste-Suprathreshold, Taste-Quadrant, Flavor Discrimination)
Relevant lab studies (hematocrit, hemoglobin, WBC, BUN, creatinine, glucose, ESR, eosinophil count, IgE, TSH, zinc, drug assays)
Neuroimaging reports (CT or MRI) when used to rule out intracranial or peripheral nerve abnormalities
EEG reports for members with seizure history
Otolaryngology, neurology, or psychiatry consultation notes as applicable

Note

Supplemental Links and Resources

This excerpt contains supplemental links and resources that providers may use for reference or navigation to related information on the payer site.

CPB cross‑references (e.g., CPB 0307 Parkinson's Disease; CPB 0071 PET; CPB 0181 Evoked Potential Studies; CPB 0376 SPECT; CPB 0700 Rhinometry and Rhinomanometry)
Aetna site resources: Glossary, Mobile App, FAQs, Program Provisions, Legal Notices, Privacy Center, Plan Disclosures

Background and Clinical Context

Smell and taste function are closely interrelated; patients reporting taste loss often have an olfactory deficit that accounts for altered flavor perception. Common causes of smell or taste disturbance include medications, upper respiratory infections (including post‑infectious causes), nasal or sinus disease, head trauma, endocrine or metabolic disorders (for example hypothyroidism), depression, and age‑related decline. A focused clinical history and physical examination, including inspection of the nasal mucosa and appropriate standardized smell and taste testing (e.g., UPSIT or Sniffin' Sticks), are recommended to document impairment before proceeding to more advanced diagnostic work‑up such as imaging, laboratory assays, biopsy, or specialist consultations.

Key Definitions

inv-23: Anosmia / Hyposmia / Dysosmia definitions

AnosmiaAbsence of the smell sensation (complete loss of smell).

HyposmiaReduced sensitivity to odorants (partial loss of smell).

DysosmiaAltered perception of smell; includes phantosmia (perception of an odor without stimulus) and parosmia/troposmia (altered perception of an odor with stimulus present).

inv-24: Ageusia / Hypogeusia / Dysgeusia definitions

AgeusiaAbsence of the taste sensation (complete loss of taste).

HypogeusiaReduced sensitivity to tastants (partial loss of taste).

DysgeusiaAltered perception of taste, with or without the presence of a tastant.