BlueCross BlueShield of Tennessee Medical Policy Manual

Quantitative Sensory Testing

DESCRIPTION

Quantitative sensory testing (QST) systems have been proposed for use as a noninvasive assessment and quantification of sensory nerve function in individuals with symptoms of, or the potential for, neurologic damage or disease. Pain conditions evaluated may include diabetic neuropathies, complex regional pain syndrome, carpal tunnel syndrome, and other nerve entrapment/compression disorders or damage. Types of sensory testing include current perception threshold testing, pressure-specified sensory testing (PSST), vibration perception testing, and thermal sensory testing. The gold standard for evaluation of myelinated large fibers is the electromyographic nerve conduction study (EMG-NCS).

QST has not been established for use as a sole tool for diagnosis and management, but has been investigated in conjunction with standard evaluation and management procedures (e.g., physical and neurological examination, monofilament testing, pinprick, grip and pinch strength, Tinel, Phalen and Roos sign) to attempt to enhance the diagnosis and treatment planning process and confirm physical findings with quantifiable data. Stimuli used in QST includes touch, pressure, pain, thermal (warm and cold), or vibratory stimuli.

Thermal stimuli are used to evaluate pathology of small myelinated and unmyelinated nerve fibers (e.g., Vibration Perception Threshold (VPT) METER, CASE IV Computer Aided Sensory Evaluator). Pressure-specified sensory devices assess large myelinated sensory nerve function by quantifying the thresholds of pressure detected with light, static, and moving touch (e.g., NK Pressure-Specified Sensory Device™, AP-4000, Air Pulse Sensory Stimulator). Another type of sensory nerve conduction threshold test is current perception threshold testing, which involves the quantification of the sensory threshold to transcutaneous electrical stimulation (e.g., Neurometer®, Neural-Scan™, Medi-Dx 7000®, and the AXON II®). Thermal sensory testing (Contact Heat-Evoked Potential Stimulator, CHEPS) involves recording the electrical response of the brain to short heat stimuli applied to the skin.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

Published studies show a wide variety of sensitivity and specificity and are insufficient to demonstrate that evaluation by quantitative sensory testing can predict clinical events. Therefore these technologies remain investigational.

SOURCES

American Academy of Neurology (Quantitative sensory testing: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. (2003 - Reaffirmed November 15, 2008) Neurology, 60 (6), 898-904.

American Academy of Neuromuscular and Electrodiagnostic Medicine. (2011). Model policy for needle electromyography and nerve conduction studies. Retrieved February 27, 2014 from http://www.aanem.org. 

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2017). Quantitative sensory testing (2.01.39). Retrieved July 28, 2017 from BlueWeb. (19 articles and/or guidelines reviewed)

Brönnimann, B., Meier, M. L., Hou, M. Y., Parkinson, C., & Ettlin, D. A. (2016). Novel air stimulation MR-device for intraoral quantitative sensory cold testing. Frontiers in Human Neuroscience, 2016; 10: 335. (Level 5 evidence - Industry sponsored)

Centers for Medicare & Medicaid Services. CMS.gov. NCD for Sensory nerve conduction threshold tests (sNCTs) (160.23). Retrieved August 17, 2016 from https://www.cms.gov. 

Mythili, A., Dileep-Kumar, K., Subrahmanyam, A., Venkateswarlu, K., & Butchi, R. (2010). A comparative study of examination scores and quantitative sensory testing in diagnosis of diabetic polyneuropathy. International Journal of Diabetes, 30 (1), 43-48. (Level 3 evidence - Independent)

Schmid, A. Bland, J. Bhat, M. and Bennett, D. (2014) The relationship of nerve fibre pathology to sensory function in entrapment neuropathy. Brain, 137, 3186-3199. (Level 4 evidence)

U. S. Food and Drug Administration. (1998, May). Center for Devices and Radiological Health. 510k Pre-market Notification Database. K980866. Retrieved October 3, 2012 from http://www.accessdata.fda.gov.  

U. S. Food and Drug Administration. (2009, January). Center for Devices and Radiological Health. 510k Premarket Notification Database. K072882. Retrieved January 14, 2011 from http://www.accessdata.fda.gov. 

Winifred S. Hayes, Inc. Medical Technology Directory. (2014, June; last update search May 2017). Quantitative sensory testing for the diagnosis of lower extremity peripheral neuropathy. Retrieved July 28, 2017 from www.Hayesinc.com/subscribers. (70 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  1/14/2006

MOST RECENT REVIEW DATE:  9/14/2017

ID_BA

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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