Quantitative Sensory Testing
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.
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.Depending on the type of stimuli used, QST can assess both small and large fiber dysfunction. Touch and vibration measure the function of large myelinated A alpha and A beta sensory fibers (e.g., Vibration Perception Threshold (VPT) METER). Thermal stimulation devices are used to evaluate pathology of small myelinated and unmyelinated nerve fibers. They can be used to assess heat and cold sensation, as well as thermal pain thresholds testing (Contact Heat-Evoked Potential Stimulator, CHEPS). 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™).
Quantitative sensory testing (e.g., pressure-specified sensory testing, vibration perception threshold testing, thermal threshold testing, and current perception threshold testing) is considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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.
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.
Abraham, A., Albulaihe, H., Alabdali, M, Qrimli, M., Breiner, A., Barnett, C., et al. (2015). Elevated vibration perception thresholds in CIDP patients indicate more severe neuropathy and lower treatment response rates. PLOS ONE, 10 (11), e0139689. (Level 4 evidence)
American Academy of Neurology. (2003; reaffirmed November 2016). Quantitative sensory testing. Neurology, 60 (6), 898-904. Retrieved July 2, 2018 from http://n.neurology.org/content/60/6/898.full.
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2018). Quantitative sensory testing (2.01.39). Retrieved July 22, 2018 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, 10, 335. (Level 5 evidence)
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.
Hübscher, M., Moloney, N., Leaver, A., Rebbeck, T., McAuley, J.H., & Refshauge, K.M. (2013). Relationship between quantitative sensory testing and pain or disability in people with spinal pain – a systematic review and meta-analysis. Pain, 154 (9), 1497-1504. Abstract retrieved July 2, 2018 from PubMed database.
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. (1997, December). Center for Devices and Radiological Health. 510k Pre-market Notification Database. K964622. Retrieved July 2, 2018 from http://www.accessdata.fda.gov.
U. S. Food and Drug Administration. (1997, September). Center for Devices and Radiological Health. 510k Premarket Notification Database. K964815. Retrieved July 2, 2018 from http://www.accessdata.fda.gov.
Winifred S. Hayes, Inc. Medical Technology Directory. (2014, June; last update search May 2018). Quantitative sensory testing for the diagnosis of lower extremity peripheral neuropathy. Retrieved July 2, 2018 from www.Hayesinc.com/subscribers . (70 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 1/14/2006
MOST RECENT REVIEW DATE: 8/9/2018
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.
This document has been classified as public information.