CurrentBlue Cross Blue Shield - MassachusettsPolicy 258

Quantitative Sensory Testing (QST) — Coverage and Authorization

This policy governs coverage and requirements for quantitative sensory testing (including current perception threshold, pressure-specified sensory, vibration perception threshold, and thermal testing) for Blue Cross Blue Shield of Massachusetts members across commercial and Medicare products where specified.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyQuantitative Sensory Testing (QST) — Coverage and Authorization

Policy CodePolicy 258

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain precertification/preauthorization when these services are performed inpatient; lack of precertification may result in denial.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

InvestigationalInvestigational status

Not coveredOutpatient coverage (Commercial)

Precert requiredInpatient authorization

5+ codesListed codes

InsufficientEvidence strength

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Coverage Criteria

Investigational/Not Covered

Covered when ALL of the following are met

Investigational stance: Quantitative sensory testing, including but not limited to current perception threshold testing, pressure-specified sensory device testing, vibration perception threshold testing, and thermal threshold testing, is considered investigational for commercial members (Managed Care HMO/POS, PPO, Indemnity) and for Medicare HMO Blue and Medicare PPO Blue.

Evidence summarized shows insufficient diagnostic accuracy and clinical utility across modalities.

Authorization requirements and outpatient coverage

Inpatient authorization: Precertification/preauthorization is required when these services are performed inpatient.

Failure to precertify may result in administrative denial.

Outpatient commercial coverage: For Commercial Managed Care (HMO and POS), Outpatient = not a covered service. Commercial PPO and Indemnity, Outpatient = not a covered service.

Outpatient claims for these commercial products may be denied as not covered.

For Commercial Members — Managed Care (HMO and POS), Commercial PPO, and Indemnity — outpatient quantitative sensory testing (QST) is not a covered service. Claims for outpatient QST submitted for these commercial products may be denied as not covered.

No additional explicit exclusions are reproduced in this policy beyond the outpatient coverage restrictions above. The policy references the CMS National Coverage Determination (NCD 160.23) for sensory nerve conduction threshold tests (sNCTs), which contains separate coverage guidance and may inform payer-specific decisions.

The available evidence is judged insufficient to establish diagnostic accuracy or clinical utility for multiple QST modalities. Specifically, studies of current perception threshold testing, pressure-specified sensory testing, vibration perception testing (VPT), and thermal sensory testing have not demonstrated reliable accuracy or direct evidence of improved health outcomes. Because test performance is not adequately established, an indirect chain of evidence for clinical utility cannot be constructed; therefore these modalities are considered investigational / not medically necessary.

Coding and Billing

Investigational CPT CodesCPTNot Covered

0106T	Quantitative sensory testing (QST), testing and interpretation per extremity; using touch pressure stimuli to assess large diameter sensation.
0107T	Quantitative sensory testing (QST), testing and interpretation per extremity; using vibration stimuli to assess large diameter fiber sensation.
0108T	Quantitative sensory testing (QST), testing and interpretation per extremity; using cooling stimuli to assess small nerve fiber sensation and hyperalgesia.
0109T	Quantitative sensory testing (QST), testing and interpretation per extremity; using heat-pain stimuli to assess small nerve fiber sensation and hyperalgesia.
0110T	Quantitative sensory testing (QST), testing and interpretation per extremity; using other stimuli to assess sensation.

Investigational HCPCS CodesHCPCSNot Covered

G0255

Current perception threshold/sensory nerve conduction test (SNCT), per limb, any nerve

Referenced tests / coverage-relevant modalitiesmixed

sNCTs

sensory Nerve Conduction Threshold Tests (as referenced in CMS NCD 160.23)

Provider Actions and Requirements

Prior Authorization

Precertification Required for Inpatient Services

For services described in this policy, precertification/preauthorization is required when the procedure is performed inpatient. Lack of required precertification may result in claim denial or reduced reimbursement.

Applies to all products when performed inpatient
Obtain precertification before inpatient admission to avoid denial

Denial Risk

Coverage Status and Outpatient Denial Risk

Quantitative sensory testing (including current perception threshold, pressure-specified sensory device testing, vibration perception threshold testing, and thermal threshold testing) is considered investigational for Commercial members and is not a covered outpatient service for certain product lines. Outpatient claims for these services may be denied for commercial members.

Commercial Managed Care (HMO and POS), Outpatient = Not a covered service

Background

Quantitative sensory testing (QST) systems noninvasively measure the magnitude of physical stimuli required for sensory perception using stimuli such as touch, pressure, vibration, thermal, or electrical current. QST can assess both large myelinated fibers (eg, touch, vibration, pressure) and small myelinated/unmyelinated fibers (eg, thermal); testing is psychophysical and requires standardized administration and a cooperative patient. Standard electrodiagnostic studies primarily evaluate large-fiber function, and there is no single criterion standard for detecting small-fiber dysfunction.

Definitions

Quantitative sensory testing (QST) — key definition

DefinitionQuantitative sensory testing (QST) measures the physical stimulus magnitude required for sensory perception using touch, pressure, vibration, thermal, or electrical stimuli to assess large and/or small fiber sensory function.

IncludesCurrent perception threshold testing, pressure-specified sensory testing, vibration perception threshold testing (VPT), and thermal sensory testing.

Psychophysical natureQST combines objective stimuli with patient response, requiring alert, cooperative patients and standardized administration to obtain reliable results.

Clinical role (most actionable)QST is not established as a sole diagnostic tool but may be used alongside physical/neurologic exam and standard electrodiagnostic studies to document sensory deficits and inform management.

Current perception threshold testing — CPT/technique

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyQuantitative Sensory Testing (QST) — Coverage and Authorization

Policy CodePolicy 258

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain precertification/preauthorization when these services are performed inpatient; lack of precertification may result in denial.

SourceLink

On This Page

Commercial PPO and Indemnity, Outpatient = Not a covered service

Investigational status increases outpatient denial risk for commercial members

Note

CMS NCD Referenced for sNCTs

The Centers for Medicare & Medicaid Services (CMS) National Coverage Determination for sensory Nerve Conduction Threshold Tests (sNCTs) (NCD 160.23) informs Medicare coverage and may affect prior authorization and coverage determinations. Providers should reference the CMS NCD when requesting authorization or appealing denials.

CMS NCD: https://www.cms.gov/medicarecoverage-database/details/ncd-details.aspx?NCDId=270&ncdver=2

Billing Rule

Coding and Documentation Reminder

Report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, and include appropriate modifiers. Accurate coding and documentation are required to support medical necessity and payment.

Use current CPT, HCPCS, ICD-10, revenue codes, and modifiers as applicable
Inclusion or exclusion of a code in this policy does not guarantee coverage; verify member contract

Documentation Required

Guideline-Supported Documentation

Clinical documentation should align with guideline-supported standards, including the American Academy of Neurology (AAN) guidance on Quantitative Sensory Testing and current Diabetes Care standards for neuropathy screening and diagnosis. Provide sufficient clinical context to demonstrate how testing informs diagnosis or management.

AAN QST report: https://www.aan.com/Guidelines/home/GuidelineDetail/87
Diabetes Care standards: Retinopathy, Neuropathy, and Foot Care - 2026

Note

This callout is reserved for any uncategorized provider instructions or actions not covered above. Include relevant operational notes here when needed.

Use this space for additional provider action items if applicable

Current perception threshold testing quantifies the sensory threshold to transcutaneous electrical stimulation, typically at three frequencies: 5 Hz (C fibers), 250 Hz (A-delta fibers), and 2000 Hz (A-beta fibers).

CodingReported in this policy under HCPCS code G0255 as current perception threshold/sensory nerve conduction test (SNCT), per limb, any nerve.

Use and comparisonResults are compared with a reference population; used to assess fiber-specific sensory thresholds but considered psychophysical and subject to variability.

QST — psychophysical test note

Psychophysical testsQST modalities are psychophysical: they combine objective physical stimuli with the subject's response, so results depend on patient cooperation and standardized instructions.

ReproducibilityPsychophysical tests have greater inherent variability, making results more difficult to reproduce compared with nerve conduction studies.

Requirements for reliabilityReliable QST requires trained staff, consistent stimulus application, and standardized patient instructions.

sensory Nerve Conduction Threshold Tests (sNCTs) — CMS NCD reference

Definitionsensory Nerve Conduction Threshold Tests (sNCTs) are electrophysiologic tests that measure sensory nerve conduction thresholds.

ReferenceThis policy cites the CMS National Coverage Determination (NCD 160.23) for sNCTs which may inform coverage decisions and prior authorization requirements.

ContextsNCTs are distinct from psychophysical QST modalities and are referenced separately in the CMS NCD and literature reviews cited in the policy.