BlueCross BlueShield of Tennessee Medical Policy Manual

Dynamic Posturography in the Assessment of Balance

Dynamic posturography (i.e., computerized dynamic posturography) tests balance control in situations intended to isolate the factors that affect balance in everyday experiences. The individual wears a harness to prevent falls and stands on an enclosed platform surrounded by a visual field. By altering the angle of the platform or shifting the visual field, the test is intended to assess movement coordination and the sensory organization of visual, somatosensory, and vestibular information relevant to postural control.

An example of a U.S. Food and Drug Administration (FDA) approved dynamic posturography device is NeuroCom EquiTest®.

POLICY

IMPORTANT REMINDER

We develop Medical Policies to provide guidance to Members and Providers.  This Medical Policy relates only to the services or supplies described in it.  The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy.  For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed.  If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.

ADDITIONAL INFORMATION

Existing studies fail to provide adequate data to evaluate this technology as a diagnostic test.

The lack of randomized controlled studies and poor quality of published studies provide no evidence of the health outcome effects of treatment decisions based on dynamic posturography.

SOURCES

BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2009). Dynamic posturography (2.01.02). Retrieved February 2, 2010 from BlueWeb. (19 articles and/or guidelines reviewed)

Gouveris, H., Stripf, T., Victor, A., & Mann, W. (2007). Dynamic posturography findings predict balance status in vestibular schwannoma patients. Otology and Neurotology, 28 (3), 372-375. Abstract retrieved June 26, 2007 from PubMed database.

Technology Evaluation Center. (1996, September). Dynamic posturography in the assessment of vestibular dysfunction (Vol. 11, No. 11). Chicago: BlueCross BlueShield Association. (28 articles and/or guidelines reviewed)

U.S. Food and Drug Administration. (1995, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K951771. Retrieved February 2, 2010 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=105728.

ORIGINAL EFFECTIVE DATE:  9/1992

MOST RECENT REVIEW DATE:  4/8/2010

ID_BT

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