I95.1 — Orthostatic hypotension
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When submitting claims for Sudoscan/ESC testing using CPT 95999, the term SUDOSCAN or ESC (electrochemical skin conductance) must be entered in the narrative/remarks field (Item 19) on the CMS-1500 claim form or electronic equivalent.
- Providers must document that autonomic testing is reasonable and necessary consistent with LCD L35395 and retain supporting medical records per LCD requirements.
- Providers should consult and document coding/reporting consistent with the current year CPT manual for appropriate CPT assignments for autonomic function testing.
- The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Key Coverage Criteria
- Autonomic function tests are covered when they meet the reasonable and necessary requirements of Local Coverage Determination (LCD) L35395.
- Cardiovagal innervation testing should be reported when performed using CPT code 95921.
- Vasomotor adrenergic innervation testing should be reported when performed using CPT code 95922.
- Sudomotor (sweat) function testing should be reported when performed using CPT code 95923, provided the testing meets the CPT-defined subject preparation, environmental, and personnel requirements.
- Combined parasympathetic and sympathetic adrenergic function testing should be reported when performed using CPT code 95924.
- Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
20 Active Policies
L34594 — Nerve Conduction Studies and Electromyography
J05
L35124 — Autonomic Function Testing
J05
A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography
J05
A57551 — Billing and Coding: Autonomic Function Testing
J05
L35098
Related Codes
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