Autonomic nervous system testing, consisting of a battery of tests in several domains (see Policy Guidelines section), may be considered medically necessary when the following criteria are met:
Signs and/or symptoms of autonomic dysfunction are present; AND
A definitive diagnosis cannot be made from clinical examination and routine laboratory testing alone; AND
Diagnosis of the suspected autonomic disorder will lead to a change in management or will eliminate the need for further testing.
Autonomic nervous system testing is considered investigational in all other situations when criteria are not met, including but not limited to the evaluation of the following conditions:
chronic fatigue syndrome
fibromyalgia
anxiety and other psychologic disorders
sleep apnea
allergic conditions
hypertension
screening of asymptomatic individuals
monitoring progression of disease or response to treatment.
Autonomic nervous system testing using portable automated devices is considered investigational for all indications (see Policy Guidelines section).
