ModifiedCignaPolicy Medical Coverage Policy: 0506

Autonomic Nerve Function Testing

This Cigna coverage policy governs when autonomic nerve function testing (sudomotor, cardiovagal, adrenergic, and combined testing) is considered medically necessary for members and which diagnoses and CPT/ICD-10 codes are applicable.

Policy Summary

PayerCigna

PolicyAutonomic Nerve Function Testing

Policy CodePolicy Medical Coverage Policy: 0506

Change TypeRemoved statement on portable automated devices

Effective Date

Next Review DateFeb 15, 2026

Key ActionWhen billing, providers must use the most appropriate covered procedure codes and submit services in accordance with the Coverage Policy.

SourceLink

POLICY UPDATE CHANGES

Removed policy statement for portable, automated autonomic nerve function testing devices.

No clinical policy statement changes noted in the 2/15/2026 annual review.

4CPT covered

10+Example ICD-10

>=5 minTilt duration

multipleAutomated devices

NCApplicable state

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Coverage Criteria for Autonomic Nerve Function Testing

Medically necessary indications

Covered when testing is used to evaluate autonomic nerve function and aid in the diagnosis of ANY of the following conditions:

Covered Indications: Distal small fiber neuropathy; Postural tachycardia syndrome; Reflex sympathetic dystrophy (e.g., sympathetically maintained pain, causalgia); Recurrent, unexplained syncope; Progressive autonomic neuropathies including diabetic autonomic neuropathy, amyloid neuropathy, Sjogren's syndrome, idiopathic neuropathy, pure autonomic failure, multiple system atrophy (Shy-Drager syndrome)

Each listed condition individually qualifies as a covered indication per policy.

Automated/portable ANS testing

Not supported/validated

Automated tests not validated: Automated/portable autonomic testing devices and simplified office-based tests (e.g., Sudoscan, EZSCAN, ANS Sudopath Complex, ANX 3.0, neuropad, etc.) have not been validated in the scientific literature; results may be erroneous and are not considered established methods of testing.

These devices typically lack beat-to-beat or Valsalva/expiration controls, often do not involve physician interpretation, and have inconsistencies in technique and normative values; interpretation cannot be validated without beat-to-beat BP or expiratory pressure control.

Medically necessary testing criteria

Covered when testing is indicated by clinical presentation and performed in an appropriate setting by qualified personnel:

Primary coverage criteria: Testing is appropriate for patients with indications such as autonomic failure, peripheral polyneuropathy (including diabetic and distal small fiber neuropathy), ganglionopathy, orthostatic hypotension, orthostatic intolerance/POTS, recurrent or unexplained syncope, neurodegenerative disorders with autonomic failure (including multiple system atrophy, Parkinson disease, Lewy body dementia), hyperadrenergic states, heat intolerance, and regional autonomic failure.

Based on AAS/AAN/IFCN and AANEM recommendations.

Test modality and setting: Assessment should include evaluation of cardiovagal, vasomotor adrenergic, and sudomotor function using validated tests (e.g., continuous beat-to-beat heart rate and blood pressure during Valsalva and tilt, heart rate response to deep breathing, QSART, thermoregulatory sweat test). Testing should be performed in a clinical autonomic laboratory by healthcare professionals with comprehensive ANS expertise and with physician interpretation on-site.

AAS/AAN/IFCN (2021) and AANEM (2023, 2025) guidance specify required measures and qualified personnel.

Autonomic nerve function testing is medically necessary when used to evaluate autonomic nerve function and to aid in the diagnosis of any of the listed conditions, including but not limited to distal small fiber neuropathy, postural tachycardia syndrome (POTS), reflex sympathetic dystrophy, recurrent unexplained syncope, diabetic autonomic neuropathy, amyloid neuropathy, Sjögren's syndrome, idiopathic neuropathy, pure autonomic failure, and multiple system atrophy (Shy-Drager syndrome). Testing performed to diagnose conditions not listed in the policy is not covered or reimbursable.

Automated or portable autonomic nerve function testing devices that do not provide continuous beat-to-beat blood pressure recordings, do not permit physician interpretation, or omit validated physiologic measures (for example, expiratory pressure control during Valsalva) are not validated and are cautioned against. The policy notes that these simplified, office-based systems frequently lack controls for medications, respiration, expiratory pressures, and beat-to-beat blood pressure, which undermines the validity of their results and may lead to unreliable clinical interpretation.

Automated or simplified devices that rely on skin moisture or conductance measurements (for example, Sudoscan, EZSCAN, ANS Sudopath Complex) have not been established as tests of autonomic function because they do not evaluate sudomotor axon integrity and show inconsistencies in technique, normative values, sensitivity, and specificity. Therefore, such devices without validated beat-to-beat or tilt/Valsalva measurements are considered not validated and their results may be erroneous.

The use of automated autonomic testing systems without physician interpretation and lacking essential physiologic measures (such as beat-to-beat blood pressure or expiratory pressure control) is discouraged. Professional society guidance states that automated testing without physician oversight has not been validated, lacks a sound physiologic basis, and can be misleading; interpretation of autonomic test results should be performed in a clinical autonomic laboratory by qualified personnel with physician interpretation on-site.

Coding: CPT and ICD-10 Details

Covered CPT CodesCPTCovered

95921	Testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio
95922	Testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least 5 minutes of passive tilt.
95923	Testing of autonomic nervous system function; sudomotor, including 1 or more of the following: quantitative sudomotor axon reflex test (QSART), silastic sweat imprint, thermoregulatory sweat test, and changes in sympathetic skin potential.
95924	Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt

Example ICD-10-CM Diagnosis Codes listed for coverageICD-10

A50.43	Late congenital syphilitic polyneuropathy
E11.43	Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E85.81	Light chain (AL) amyloidosis
G90.A	Postural orthostatic tachycardia syndrome [POTS]
R55	Syncope and collapse
M35.00	Sjögren syndrome, unspecified

Not covered ICD-10 codesICD-10Not Covered

All other codes

All other ICD-10-CM diagnosis codes not listed are not covered or reimbursable

Automated/portable devices (listed; not validated)mixedExperimental

ANS Sudopath Complex; Plus	Commercial automated ANS testing device (listed as unvalidated)
Sudoscan	Commercial automated sudomotor/sweat conductance device (listed as unvalidated)
EZSCAN	Commercial automated sudomotor device (listed as unvalidated)

Covered CPT Codes (mentioned)CPTCovered

95924

Combined parasympathetic and sympathetic testing with tilt table

Example FDA 510(k) device identifiersmixed

K173916	Finapres NOVA (FDA 510(k) identifier)
K092809	HRV Acquire (FDA 510(k) identifier)
K992874	Q-Sweat Quantitative Sweat Measurement System (FDA 510(k) identifier)
K100233	Sudoscan (FDA 510(k) identifier)
K191266	VitalScan ANS (FDA 510(k) identifier)

inv-14: Passive tilt duration — at least 5 minutes (operational threshold)

Required passive tilt durationAt least 5 minutes of passive tilt is required for vasomotor/combined testing (CPT 95922, 95924).

Associated CPT codesCPT 95922 and CPT 95924 specify inclusion of ≥5 minutes passive tilt in their descriptions.

Operational useUsed during tilt-table components to evaluate vasomotor adrenergic function and to differentiate sympathetic vs parasympathetic contributions.

Provider Responsibilities, Prior Authorization, and Billing

Billing Rule

Code requirements for coverage

Coverage depends on the applicable plan document and correct coding. When billing, providers must use the most appropriate codes as of the date of submission. Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.

Use the most appropriate codes for the date of service.
Submit services only with covered diagnosis/procedure codes per the applicable benefit plan document.

Denial Risk

Denial triggers

Claims lacking covered procedure codes, missing or insufficient documentation of the medical history/exam, or failure to demonstrate that testing met clinical indications will be denied. Also, claims for automated device-only testing without physician interpretation, or for tests not supported by the applicable plan document, may be denied.

Background

The autonomic nervous system regulates internal organ function through its sympathetic and parasympathetic branches, maintaining physiologic processes such as blood pressure, heart rate, thermoregulation, and sweating. Disorders of the autonomic nervous system may be structural (for example, autonomic failure) or functional/syndromic (for example, POTS). Autonomic testing — including cardiovagal, vasomotor adrenergic, and sudomotor assessments — helps evaluate nerve integrity, localize dysfunction, and guide diagnosis and management. These evaluations are typically performed in specialized clinical autonomic laboratories using continuous ECG, respiration monitoring, beat-to-beat blood pressure measurements, and, when appropriate, tilt table testing.

Definitions and Test Descriptions

inv-24: Sudomotor testing — sweat-related tests (QSART, thermoregulatory sweat test, silastic imprint, SSR).

DefinitionSweat-related tests that assess postganglionic sudomotor nerve function and sweat gland responses (e.g., QSART, thermoregulatory sweat test, silastic imprint, sympathetic skin response).

Example methodsQuantitative sudomotor axon reflex test (QSART), thermoregulatory sweat test (TST), silastic sweat imprint, changes in sympathetic skin potential (SSR).

Clinical roleUsed to assess neuropathy affecting sudomotor fibers as part of comprehensive autonomic evaluation in a dedicated autonomic laboratory.

inv-25: Cardiovagal testing (CPT 95921) — heart rate response to deep breathing, Valsalva ratio, etc.

Definition (CPT 95921)Standardized quantitative assessment of cardiovagal (parasympathetic) innervation to the heart including heart rate response to deep breathing, Valsalva ratio, and heart rate response to standing.

Revision History and Policy Changes

2026-02-15annual_reviewLatest

Removed policy statement for portable, automated autonomic nerve function testing devices.

2025-02-15annual_review

No clinical policy statement changes during the annual review.

2024-02-15annual_review

Policy Summary

PayerCigna

PolicyAutonomic Nerve Function Testing

Policy CodePolicy Medical Coverage Policy: 0506

Change TypeRemoved statement on portable automated devices

Effective Date

Next Review DateFeb 15, 2026

Key ActionWhen billing, providers must use the most appropriate covered procedure codes and submit services in accordance with the Coverage Policy.

SourceLink

On This Page

Missing or non-covered CPT/diagnosis codes will result in denial.
Insufficient clinical documentation (history, exam, indications, physician interpretation) will result in denial.
Claims for services not consistent with the member's benefit plan or applicable Coverage Policy will be denied.

Denial Risk

Automated device limitations may lead to denial

Automated, portable autonomic testing devices that do not provide beat-to-beat blood pressure, expiratory pressure measurements, or lack physician review and interpretation are not validated and have limitations. Use of reports solely from such automated devices without supporting physiologic data and physician interpretation may lead to claim denial.

Automated devices that omit beat-to-beat blood pressure or expiratory pressure (e.g., many sweat/conductance-only systems) lack validated physiologic measures.
Devices or tests marketed without physician interpretation or control for confounders (medications, respiration, room conditions) may be denied.
FDA clearance alone does not guarantee coverage.

Documentation Required

Documentation and interpretation requirements

Interpretation should be performed by a qualified physician and based on the medical history and physical examination. Reports must document consideration of potential confounders (medications, equipment settings, room conditions, patient factors) and include physician-supervised interpretation referencing the testing battery and physiologic data.

Documentation must include the patient's history, physical exam findings, indication for testing, and the specific tests performed.
Interpretation must address confounding factors (medications, respiration, room conditions, patient effort) and reference the underlying physiologic recordings when applicable (e.g., beat-to-beat HR and BP for Valsalva).
Physician qualification: studies should be performed/interpreted by clinicians with expertise in autonomic disorders per professional society guidance.

Prior Authorization

Prior authorization for combined or device-based testing

Prior authorization may be required for certain combined or device-based testing per the plan or applicable submission rules. Verify prior authorization requirements with the member's benefit plan before scheduling testing.

Prior authorization may be required for combined testing (e.g., CPT 95924) or for testing using certain devices — check the member's plan.
If prior authorization is required and not obtained, the claim may be denied or subject to reduced payment.

Measured parametersHeart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and the 30:15 ratio.

Clinical interpretationImpairment may indicate diabetic neuropathy, multiple system atrophy, idiopathic hypotension, or other autonomic neuropathies.

inv-26: Vasomotor adrenergic testing (CPT 95922) — beat-to-beat BP responses during tilt/Valsalva/standing.

Definition (CPT 95922)Evaluation of vasomotor adrenergic (sympathetic) innervation using beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver, tilt-testing, or standing.

Measured parametersBeat-to-beat blood pressure responses during tilt or Valsalva and associated heart rate (R-R interval) changes.

Clinical roleEnhances sensitivity/specificity for adrenergic dysfunction; abnormalities seen in multiple system atrophy, idiopathic orthostatic hypotension, and diabetic/autonomic neuropathies.

inv-27: Combined testing with tilt (CPT 95924) — includes at least a 5-minute passive tilt.

Definition (CPT 95924)Combined parasympathetic and sympathetic adrenergic cardiovascular testing that includes at least a 5-minute passive tilt table component.

PurposePerformed when differentiation between sympathetic and parasympathetic cardiovascular function is needed.

Test componentsTypically includes parasympathetic assessments (e.g., cardiovagal tests) plus vasomotor adrenergic evaluation via passive tilt ≥5 minutes.

inv-28: Combined parasympathetic and sympathetic testing (CPT 95924) — simultaneous assessment often using passive tilt.

DefinitionSimultaneous assessment of cardiovagal (parasympathetic) and vasomotor adrenergic (sympathetic) function—often accomplished using parasympathetic tests plus a passive tilt table for sympathetic evaluation.

Typical implementationCombines heart rate maneuvers (deep breathing, Valsalva) with beat-to-beat BP monitoring during at least a 5-minute passive tilt to evaluate both branches concurrently.

Coding noteCaptured by CPT 95924 when combined testing includes the required passive tilt duration.

inv-29: Portable/Automated ANS testing devices — definition of automated devices that perform combined testing without beat-to-beat recording.

DefinitionAutomated/portable ANS testing devices: simplified, often office-based systems that perform combined autonomic testing without continuous beat-to-beat blood pressure recordings or validated tilt/Valsalva controls.

Common characteristicsMay record skin conductance/moisture or simplified signals, frequently lack expiratory pressure control, beat-to-beat BP, and often do not include physician interpretation.

Examples (commercially marketed)ANS Sudopath Complex; Plus; EZSCAN; Sudoscan; ANX 3.0; Finapres NOVA; neuropad; VitalScan ANS (listed in the policy as unvalidated).

Policy stanceThese devices are not validated in the scientific literature; results may be erroneous and their use is cautioned against for diagnostic autonomic testing.

Revised noncoverage policy statement.