Billing and Coding: Autonomic Function Tests

This billing and coding guidance requires specific component completion to bill autonomic function CPT codes: CPT 95921 requires at least two parasympathetic tests, CPT 95922 requires both Valsalva and ≥5 minutes passive tilt, and CPT 95924 requires combined parasympathetic and vasomotor testing with ≥5 minutes tilt. QSART is used to assess distal postganglionic sympathetic fibers (optimally 1 forearm + 3 lower-extremity sites). All services must meet the indications and limitations in LCD L33609, applicable CMS NCDs, general Medicare medical necessity rules, and documentation (including a treating practitioner order per CFR 42 Part 410.32(a)) must be maintained.

"Report CPT 95921 when at least two parasympathetic cardiovagal tests are performed (heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio)."

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