263 Form

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Medical Policy Dynamic Posturography
Table of Contents • Policy: Commercial • Coding Information
• Information Pertaining to All Policies
• Policy: Medicare • Description
• References
• Authorization Information • Policy History

Policy Number: 263

BCBSA Reference Number: 2.01.02 (For Plan internal use only) NCD/LCD: N/A Related Policies
Vestibular Function Testing, #024 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity
Medicare HMO BlueSM and Medicare PPO BlueSM Members

Dynamic posturography is considered INVESTIGATIONAL.

Prior Authorization Information
Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient.
Outpatient • For services described in this policy, see below for products where prior authorization might be required if the procedure is performed outpatient.

Outpatient Commercial Managed Care (HMO and POS) This is not a covered service. Commercial PPO and Indemnity This is not a covered service. Medicare HMO BlueSM This is not a covered service. Medicare PPO BlueSM This is not a covered service. CPT Codes / HCPCS Codes / ICD Codes Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

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Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable. The following codes are included below for informational purposes only; this is not an all-inclusive list.

The following CPT code is considered investigational for Commercial Members: Managed Care (HMO and POS), PPO, Indemnity, Medicare HMO Blue and Medicare PPO Blue: CPT Codes CPT codes:

Code Description 92548 Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; 92549 Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (MCT) and adaptation test (ADT)

Description Balance Disorders Complaints of imbalance are common in older adults and contribute to the risk of falling in this population. Falls are an important cause of death and disability in this population in the United States. Maintenance of balance is a complex physiologic process, requiring the interaction of the vestibular, visual, and proprioceptive/somatosensory system, and central reflex mechanisms. Balance is also influenced by the general health of the patient (ie, muscle tone, strength, range of motion). Therefore, identifying and treating the underlying balance disorder can be difficult. Commonly used balance function tests (eg, electronystagmography, rotational chair tests) attempt to measure the extent and site of a vestibular lesion but do not assess the functional ability to maintain balance.

Role in Diagnosis Dynamic posturography aims to provide quantitative information on a patient’s functional ability to maintain balance. The patient, wearing a harness to prevent falls, stands on an enclosed platform surrounded by a visual field. By altering the angle of the platform or shifting the visual field, the test assesses movement coordination and the sensory organization of visual, somatosensory, and vestibular information relevant to postural control. The patient undergoes 6 different testing situations designed to evaluate the vestibular, visual, and proprioceptive/somatosensory components of balance. In general terms, the test measures an individual’s balance (as measured by a force platform to calculate the movement of the patient’s center of mass) while visual and somatosensory cues are altered. These tests vary by whether eyes are open or closed, the platform is fixed or sway-referenced, and whether the visual surround is fixed or sway- referenced. Sway-referencing involves making instantaneous computer-aided alterations to the platform or visual surround to coincide with changes in body position produced by sway. The purpose of sway- referencing is to cancel out accurate feedback from somatosensory or visual systems that are normally involved in maintaining balance. In the first 3 components of the test, the support surface is stable, and visual cues are either present, absent, or sway-referenced. In tests 4 to 6, the support surface is sway- referenced to the individual, and visual cues are either present, absent, or sway-referenced. In tests 5 and 6, the only accurate sensory cues available for balance are vestibular cues. Results of computerized dynamic posturography have been used to determine what type of information (ie, visual, vestibular, proprioceptive) can and cannot be used to maintain balance. Dynamic posturography cannot be used to localize the site of a lesion.

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Posturography tests a patient’s balance control in situations intended to isolate factors that affect balance in everyday experiences. Balance can be rapidly assessed qualitatively by asking the patient to maintain a steady stance on a flat or compressible surface (ie, foam pads) with the eyes open or closed. By closing the eyes, the visual input into balance is eliminated. Use of foam pads eliminates the sensory and proprioceptive cues. Therefore, the only vestibular input is available when standing on a foam pad with eyes closed. Summary Dynamic posturography tests an individual's balance control in situations intended to isolate factors that affect balance in everyday experiences. Posturography provides quantitative information on the degree of imbalance present but is not intended to diagnose specific types of balance disorders.

Summary of Evidence For individuals with suspected balance disorders who receive dynamic posturography, the evidence includes cross-sectional comparisons of results in patients with balance disorders and healthy controls and retrospective case series reporting outcomes for patients assessed with dynamic posturography as part of clinical care. Relevant outcomes are test accuracy and validity, symptoms, and morbid events. There are no generally accepted reference standards for dynamic posturography, which makes it difficult to determine how testing results can be applied to clinical care. There are no studies demonstrating the clinical utility of the test that would lead to changes in management that improve outcomes (eg, symptoms, function). The evidence is insufficient to determine that the technology results in an improvement in the net health outcome. Policy History Date Action 4/2026 Annual policy review. Policy updated with literature review through December 10, 2025; references added. Policy statement unchanged. 4/2025 Annual policy review. Policy updated with literature review through December 10, 2024; no references added. Policy statement unchanged. 4/2024 Annual policy review. References updated. Policy statements unchanged. 4/2023 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 3/2022 Annual policy review. Policy statements unchanged. 5/2021 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 4/2020 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 1/2020 Clarified coding information. 4/2019 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 3/2017 Annual policy review. New references added. 3/2016 Annual policy review. New references added. 12/2015 Added coding language. 12/2014 Annual policy review. New references added. 2/2014 Annual policy review. New references added. 11/2011-4/2012 Medical policy ICD 10 remediation: Formatting, editing and coding updates. No changes to policy statements.
1/2011 Reviewed - Medical Policy Group – Neurology and Neurosurgery. No changes to policy statements.
1/2010 Reviewed - Medical Policy Group – Neurology and Neurosurgery. No changes to policy statements. 1/2010 Annual Policy Review. No changes to policy statements.

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1/2009 Reviewed - Medical Policy Group – Neurology and Neurosurgery. No changes to policy statements. 7/2008 Annual Policy Review. No changes to policy statements.
1/2008 Reviewed - Medical Policy Group – Neurology. No changes to policy statements. 6/2007 Annual Policy Review. No changes to policy statements. 1/2007 Reviewed - Medical Policy Group – Neurology. No changes to policy statements. Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines

References

1. Fritz NE, Newsome SD, Eloyan A, et al. Longitudinal relationships among posturography and gait measures in multiple sclerosis. Neurology. May 19 2015; 84(20): 2048-56. PMID 25878185
2. Ferrazzoli D, Fasano A, Maestri R, et al. Balance Dysfunction in Parkinson's Disease: The Role of Posturography in Developing a Rehabilitation Program. Parkinsons Dis. 2015; 2015: 520128. PMID 26504611
3. Buatois S, Gueguen R, Gauchard GC, et al. Posturography and risk of recurrent falls in healthy non- institutionalized persons aged over 65. Gerontology. 2006; 52(6): 345-52. PMID 16905886
4. Girardi M, Konrad HR, Amin M, et al. Predicting fall risks in an elderly population: computer dynamic posturography versus electronystagmography test results. Laryngoscope. Sep 2001; 111(9): 1528-32. PMID 11568601
5. Sinaki M, Lynn SG. Reducing the risk of falls through proprioceptive dynamic posture training in osteoporotic women with kyphotic posturing: a randomized pilot study. Am J Phys Med Rehabil. Apr 2002; 81(4): 241-6. PMID 11953540
6. Whitney SL, Marchetti GF, Schade AI. The relationship between falls history and computerized dynamic posturography in persons with balance and vestibular disorders. Arch Phys Med Rehabil. Mar 2006; 87(3): 402-7. PMID 16500176
7. Soylemez E, Tokgoz-Yilmaz S. Predicting fall risk in elderly ındividuals: a comparative analysis of machine learning models using patient characteristics, functional balance tests and computerized dynamic posturography. J Laryngol Otol. Jun 2025; 139(6): 464-472. PMID 39523530
8. Ganesan M, Pasha SA, Pal PK, et al. Direction specific preserved limits of stability in early progressive supranuclear palsy: a dynamic posturographic study. Gait Posture. Apr 2012; 35(4): 625-9. PMID 22225854
9. Lee JM, Koh SB, Chae SW, et al. Postural instability and cognitive dysfunction in early Parkinson's disease. Can J Neurol Sci. Jul 2012; 39(4): 473-82. PMID 22728854
10. Pierchała K, Lachowska M, Morawski K, et al. [Sensory Organization Test outcomes in young, older and elderly healthy individuals--preliminary results]. Otolaryngol Pol. 2012; 66(4): 274-9. PMID 22890532
11. Biggan JR, Melton F, Horvat MA, et al. Increased load computerized dynamic posturography in prefrail and nonfrail community-dwelling older adults. J Aging Phys Act. Jan 2014; 22(1): 96-102. PMID 23416307
12. Lim KB, Lee HJ. Computerized posturographic measurement in elderly women with unilateral knee osteoarthritis. Ann Rehabil Med. Oct 2012; 36(5): 618-26. PMID 23185725
13. Alahmari KA, Marchetti GF, Sparto PJ, et al. Estimating postural control with the balance rehabilitation unit: measurement consistency, accuracy, validity, and comparison with dynamic posturography. Arch Phys Med Rehabil. Jan 2014; 95(1): 65-73. PMID 24076084
14. Teggi R, Caldirola D, Fabiano B, et al. Rehabilitation after acute vestibular disorders. J Laryngol Otol. Apr 2009; 123(4): 397-402. PMID 18549515

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15. Badke MB, Miedaner JA, Shea TA, et al. Effects of vestibular and balance rehabilitation on sensory organization and dizziness handicap. Ann Otol Rhinol Laryngol. Jan 2005; 114(1 Pt 1): 48-54. PMID 15697162
16. Badke MB, Shea TA, Miedaner JA, et al. Outcomes after rehabilitation for adults with balance dysfunction. Arch Phys Med Rehabil. Feb 2004; 85(2): 227-33. PMID 14966706
17. Brown KE, Whitney SL, Marchetti GF, et al. Physical therapy for central vestibular dysfunction. Arch Phys Med Rehabil. Jan 2006; 87(1): 76-81. PMID 16401442
18. Hirsch MA, Toole T, Maitland CG, et al. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Arch Phys Med Rehabil. Aug 2003; 84(8): 1109-17. PMID 12917847
19. Nocera J, Horvat M, Ray CT. Effects of home-based exercise on postural control and sensory organization in individuals with Parkinson disease. Parkinsonism Relat Disord. Dec 2009; 15(10): 742-
20. PMID 19640769
21. Lundin F, Ledin T, Wikkelsø C, et al. Postural function in idiopathic normal pressure hydrocephalus before and after shunt surgery: a controlled study using computerized dynamic posturography (EquiTest). Clin Neurol Neurosurg. Sep 2013; 115(9): 1626-31. PMID 23489444
22. American Academy of Otolaryngology-Head and Neck Surgery. Position Statement: Posturography. 2007 (revised 2014); https://www.entnet.org/resource/position-statement-posturography/. Accessed December 10, 2025.
23. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. Mar 2017; 156(3_suppl): S1-S47. PMID 28248609