BlueCross BlueShield of Tennessee Medical Policy Manual

Autonomic Nervous System Testing

Autonomic nervous system (ANS) testing evaluates the physiologic responses to various stimuli. It is not a test for a specific disease; instead it investigates the degree of dysfunction of part of the nervous system. This can aid in localization of the dysfunction, narrowing of the differential diagnosis, and in some cases, making a clear diagnosis.

As the ANS controls physiologic processes that are not under conscious control; autonomic testing may not be able to differentiate between similar disorders that both cause autonomic dysfunction, but may be able to quantify the severity of autonomic dysfunction. In other cases, autonomic testing may exclude autonomic dysfunction and thereby lead to specific recommendations for treatment.

Although there is not a standard battery of tests for ANS testing, testing generally consists of individual tests in three domains: cardiovagal function, vasomotor adrenergic function and sudomotor function.  Tests within these categories may include:





ANS testing should be performed in the setting of a dedicated ANS testing laboratory, under closely controlled conditions and interpretation of results performed by an individual with expertise in ANS testing. Portable, automated testing that is intended for office use has not been validated by clinical studies and has a greater potential to lead to erroneous results.


American Academy of Neurology. (2009, Reaffirmed 2016). Practice parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Retrieved December 28, 2017 from

American Academy of Neurology. (2014). Autonomic testing – model coverage policy. Retrieved February 18, 2015 from

American Association of Neuromuscular & Electrodiagnostic Medicine. (2017, May). Proper performance of autonomic function testing. Retrieved December 28, 2017 from

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2017). Autonomic nervous system testing (2.01.96). Retrieved Deceember 28, 2017 from BlueWeb. (22 articles and/or guidelines reviewed)

Cahaba Government Benefit Administrators, LLC. (2015, October). LCD for medicine: autonomic function tests (L34500). Retrieved March 22, 2016 from

Chelimsky, G., Ialacci, S., and Chelimsky, T. (2013).  Autonomic testing in healthy subjects - preliminary observations. Clinical Autonomic Research. 23 (2): 113-116. (Level 3 evidence)

Coon, E., Sletten, D., Suarez, M., Mandrekar, J., Ahlskog, J., et al. (2015). Clinical features and autonomic testing predict survival in multiple system atrophy. Brain, 138, 3623-3631. (Level 4 evidence)

Iodice, V., & Sandroni, P. (2014). Autonomic neuropathies. Continuum, 20 (5), 1373-1397. (Level 3 evidence)

Tannus, L.,  Sperandei, S.,   Montenegro Júnior, R., Carvalho, V.,  Pedrosa, H., Felix, M.,et. al. (2013). Reproducibility of methods used for the assessment of autonomous nervous system's function. Autonomic Neuroscience: Basic and Clinical. 177 (2013) 275-279. (Level 2 evidence)

Van Cauwenbergh, D., Nijs, J., Kos, D., Van Weijnen, L., Struyf, F., & Meeus, M. (2014). Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review. European Journal of Clinical Investigation, 44 (5), 516-526. Abstract retrieved February 22, 2017 from PubMed database.




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