Billing and Coding: Vestibular Function Tests

Vestibular function tests are covered when medically necessary to evaluate suspected vestibular causes of balance problems and when other causes have been ruled out, in accordance with LCD L33966 and CMS rules. CPT 92537 is intended for complete bilateral bithermal caloric testing and CPT 92538 for bilateral monothermal testing; specific coding modifiers (e.g., 52, -26, -TC) and mutual exclusivity rules (e.g., do not bill 92540 with 92541/92542/92544/92545, and do not pair Auto Head Rotation with 92546) must be followed. Detailed, legible documentation including the treating practitioner’s order, recordings, history/physical, medication review, rule-out rationale, and equipment identifiers is required to support payment.

"Vestibular function testing is covered when medically necessary to evaluate balance or suspected vestibular dysfunction and when other physiological, psychological, medication-related, or systemic ..."