G90.A — Postural orthostatic tachycardia syndrome [POTS]
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- Medical records maintained by the performing provider must clearly support medical necessity and include test reports and the interpreting provider's interpretation.
- Supporting documentation should include relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures used to rule out more common causes of autonomic signs or symptoms.
- For diagnostic tests report the test result if known; if results are not available, report the symptoms that prompted performance of the test.
Key Coverage Criteria
- Autonomic function testing is covered to confirm or exclude a specific autonomic nervous system disorder when medically necessary.
- Repeat autonomic testing for patients with a diagnosed autonomic disorder is covered when there is a documented change in clinical status or a response to a therapeutic intervention.
- No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
- To differentiate the cause of postural tachycardia syndrome (POTS).
- To evaluate an inadequate clinical response to beta blockade in patients with vasodepressor syncope.
- To evaluate distressing symptoms in patients with a clinical picture suspicious for distal small fiber neuropathy in order to diagnose the condition.
9 Active Policies
L36236 — Autonomic Function Testing
J06
A57024 — Billing and Coding: Autonomic Function Testing
J06
AETNA-CPB-0165 — Cardiac Catheter Ablation and Radioablation
AETNA-CPB-0678 — Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy
AETNA-CPB-0774 — Nerve Fiber Density Measurement
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