CurrentUnitedHealthcarePolicy CSO23PAP

Computerized Dynamic Posturography (for Pennsylvania Only)

This policy governs coverage of computerized dynamic posturography (CDP) testing for members in Pennsylvania and describes when the service is considered medically necessary or not, affecting providers requesting CDP in that state.

Policy Summary

PayerUnitedHealthcare

PolicyComputerized Dynamic Posturography (for Pennsylvania Only)

Policy CodePolicy CSO23PAP

Change TypeSupporting information updated

Effective DateApr 1, 2025

Next Review Date

Key ActionCheck the member's federal, state, or contractual benefit plan for prior authorization requirements before requesting CDP.

SourceLink

POLICY UPDATE CHANGES

Supporting Information Updated Clinical Evidence and References sections to reflect the most current information.

Pennsylvania-onlystate-specific policy application

Not coveredcoverage stance summary

2 codesprocedure codes referenced

Multiple small studiesevidence quality

Coverage Criteria — Computerized Dynamic Posturography (CDP)

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Not Medically Necessary

Not medically necessary statement

Primary Coverage Determination: Computerized dynamic posturography (CDP) testing is unproven and not medically necessary for evaluating any condition, including but not limited to balance disorders, due to insufficient evidence of efficacy.

Policy applies to Pennsylvania; requests will be evaluated case-by-case per state exceptions.

Computerized dynamic posturography (CDP), also known as balance board testing or equilibrium platform testing (EPT), is considered unproven and not medically necessary for evaluating any condition, including but not limited to balance disorders, because of insufficient evidence demonstrating its efficacy.

When federal, state, or contractual benefit plan coverage requirements conflict with this Medical Policy, the governing federal, state, or contractual requirements prevail. Before applying this policy, verify the member’s applicable benefit plan and any jurisdictional rules that may override this guidance.

Rationale: the peer-reviewed literature provides weak evidence regarding the efficacy of CDP for evaluating vestibular and other disorders. There is a lack of well-designed trials demonstrating CDP’s diagnostic utility compared with standard vestibular tests, and insufficient evidence of consistent, beneficial effects on patient‑relevant outcomes; therefore CDP is considered unproven and not medically necessary.

Coding — Affected Procedure Codes

Applicable CPT CodesCPT

92548	Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions, including interpretation and report.
92549	Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions, including interpretation and report; with motor control test (MCT) and adaptation test (ADT).

Prior authorization affected codesmixed

affected codes

Refer to member's benefit plan or prior authorization system for exact procedure/billing codes subject to prior authorization.

Pennsylvania prior authorization / code referenceCPT

92548	Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions, including interpretation and report.
92549	Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions, including interpretation and report; with motor control test (MCT) and adaptation test (ADT).

Provider Actions — Authorization, Documentation, and Denial Risk

Documentation Required

Provider responsibilities and Pennsylvania-specific requirements

This Medical Policy applies to the state of Pennsylvania. Requests for services that do not meet criteria set in the Pennsylvania Application (PARP) will be evaluated on a case-by-case basis. Providers must supply documentation to demonstrate medical necessity consistent with Pennsylvania exceptions and local requirements (see Pennsylvania Code, Title 55, Chapter 1101). Listing of codes in this policy is for reference only and does not guarantee coverage — benefit coverage is determined by federal, state, or contractual requirements and applicable laws.

UnitedHealthcare may evaluate requests on a case-by-case basis when Pennsylvania-specific criteria are not met.
Providers should include clinical documentation demonstrating medical necessity and relevance to the request, including indication, prior treatments, and diagnostic findings.
Reference the member's federal, state, or contractual benefit plan to determine coverage; contractual/state requirements take precedence over this policy when there is a conflict.

Prior Authorization

Prior Authorization Requirement

Prior authorization requirements depend on the member's specific benefit plan. Before performing services, check the member's federal, state, or contractual benefit plan. UnitedHealthcare may use third-party clinical review tools to assist in administration and authorization decisions.

Verify member benefits and any applicable prior authorization requirements prior to scheduling.
UnitedHealthcare may use third-party tools (for example, InterQual) to support clinical review.

Denial Risk

Contractual/State Override Risk

In the event of any conflict between this Medical Policy and federal, state, or contractual benefit plan requirements, the federal, state, or contractual requirements will govern and may override coverage determinations in this policy. Providers should reference and follow the applicable governing contractual/state requirements when deciding coverage or submitting requests.

If federal, state, or contractual terms differ from this policy, those terms control and may result in denial if coverage is not required under those terms.
Providers must review the member's plan documents and state mandates (Pennsylvania exceptions) when preparing prior authorization requests or appeals.

Denial Risk

Denial Risk for CDP Requests

Computerized dynamic posturography (CDP) testing is described in this policy as unproven and not medically necessary for evaluating any condition due to insufficient evidence of efficacy. Requests that do not meet Pennsylvania application criteria will be evaluated case-by-case and may be denied as not medically necessary.

CDP requests that fail to meet applicable Pennsylvania criteria are at risk for denial.
Provide clear documentation if requesting exception or case-by-case review.

Definitions

Definition

TermPlatform-based posturography (CDP)

DefinitionTesting that uses a moving or force-measuring platform to evaluate a patient’s ability to maintain balance while vision, proprioception, and vestibular inputs are systematically manipulated.

SynonymsMoving platform posturography; dynamic posturography; equilibrium platform testing (EPT)

Computerized Dynamic Posturography (CDP)

TermComputerized Dynamic Posturography (CDP)

PurposeObjective evaluation of risk of falls and assessment of immediate effects of vestibular therapy in specific populations (e.g., traumatic brain injury, children with autism spectrum disorders).

Clinical contextUsed to try to isolate vestibular contributions to balance deficits and to guide rehabilitation; complementary to standard vestibular diagnostics such as electronystagmography and rotational chair tests.

OpenPayer

Computerized Dynamic Posturography (for Pennsylvania Only)

Coverage Criteria — Computerized Dynamic Posturography (CDP)

Coding — Affected Procedure Codes

Provider Actions — Authorization, Documentation, and Denial Risk

Background — What is Computerized Dynamic Posturography (CDP)?

Definitions

Revision History