Humana Chronic Vertigo Evaluation and Treatment Form
This procedure is not covered
Description
Vertigo can be described as a dizzy or spinning sensation. Some individuals perceive self-motion whereas others perceive motion of the environment. Vertigo may be experienced as an illusion of motion, vague dizziness, imbalance, disorientation, transient spinning or a sense of swaying or tilting.
Vertigo is the predominant symptom of vestibular dysfunction and can be caused by conditions including, but not limited to, benign paroxysmal positional vertigo (BPPV), Meniere’s disease and superior semicircular canal dehiscence (SSCD). Acute vertigo will present as an isolated occurrence and has a distinct beginning and end; chronic vertigo is continuous and/or recurring.
Since vertigo is a symptom of a condition, treatment is focused on the specifics of the disease/disorder, relief of symptoms and promotion of recovery.
The treatment Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
The treatment varies according to whether the individual is suffering from acute or chronic symptoms.
Evaluation Methods
Methods for the evaluation of chronic vertigo may be generally referred to as vestibular evaluation and include, but may not be limited to:
- Caloric vestibular test – Each ear is separately irrigated with cold water and warm water, for a total of 4 irrigations, to create nystagmus in the individual. The individual is observed for any difference between the reaction of the right and the left sides. This testing can be performed with or without recording.
- During this noninvasive test, the individual stands on a platform that records postural adjustments. In conjunction with computer software, these movements are observed, recorded and measured with eyes open, shut or while wearing special goggles for controlled visual stimulation. It is purportedly designed to help quantify the severity of balance problems, diagnose balance disorders, estimate prognosis and plan treatment. CDP has also been proposed for use in balance retraining, reassessment of treatment progress and for use in the treatment of visual, vestibular or somatosensory (proprioceptor) problems. These tests may also be referred to as balance board testing, equilibrium platform testing or visual vertical testing. An example of this device is the SMART EquiTest.
- Dynamic or head shaking visual acuity test – By having the individual look at an eye chart in the distance wearing their customary distance vision eyeglasses, if applicable, the individual is asked to read the eye chart while their head is shaken continuously over a small range. Then, the individual reads the chart again while their head is immobile. A computerized system may be utilized as well to test for dynamic visual acuity.
- Electronystagmography (ENG) – With this test, eye movements are recorded and analyzed via small electrodes placed on the skin around the eyes. ENG testing is generally the same as the caloric vestibular test, optokinetic nystagmus test, positional nystagmus test and/or spontaneous nystagmus test; however, in this variation, the results are recorded in addition to being observed.
- Head impulse or head thrust test – During this test, the individual wears their usual prescription eyeglasses and is instructed to keep their eyes on a distant target, while the head is then turned quickly and unpredictably by the examiner. The normal response is that the eyes remain on the target.
- Optokinetic nystagmus test – For this exam, a rotating drum made of alternating light and dark vertical stripes is placed in front of the individual and the individual is instructed to stare at the drum without focusing on any one stripe. The eyes are observed for nystagmus while the drum is rotated in one direction. The direction of the drum is reversed. No electrodes are used.
- Peripheral vestibular, central nervous and corneo-retinal potential involvement test – An automated combination of tests that utilize five electrodes which purportedly allow physicians to test for central nervous system and peripheral vestibular involvement, as well as receive a corneo-retinal potential value in less than 25 minutes. An example of this device is the VAT-ENGplus Combo. (Refer to Coverage Limitations section)
- Positional nystagmus test (Barany or Dix-Hallpike maneuver) – This testing involves moving the individual rapidly from the sitting to the lying position with the head tilted downward off the table at 45 degrees and rotated 45 degrees to one side to assess whether the eyes can maintain a static position when the head is in a different position.
- Rotary chair testing – This testing involves sitting in a rotational computerized chair with a seat belt and security head strap. A pair of infrared video goggles are worn to record eye movements in response to movements of the chair. This test is usually an addition to ENG and videonystagmography (VNG) testing.
- Saccadic testing – A general term used to describe various evaluations for nystagmus.
- Spontaneous nystagmus test – During this test, the individual's eyes are observed for spontaneous nystagmus as the individual is asked to look straight ahead, 30 degrees to 45 degrees to the right and 30 degrees to 45 degrees to the left. No electrodes are used and no recording made.
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 4 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
The test begins with an individual securely strapped to a special table in a supine (flat) position for approximately 15 minutes. The table is then quickly lifted to an angled position similar to that of standing for approximately 45 minutes. The individual’s heart rate and blood pressure are monitored continuously throughout the test to record changes that would be similar to a syncopal episode. (Refer to Coverage Limitations section)
Vestibular autorotation test (VAT) – During this test, the individual wears a lightweight head strap with five electrodes which monitors head and eye movements. While following a moving target with the eyes, the individual moves the head back and forth or up and down in time with gradually accelerating computer-generated tones. (Refer to Coverage Limitations section)
Vestibular evoked myogenic potential (VEMP) – This testing examines otolith and vestibular nerve function by measuring muscle responses or electrical activity in response to nerve stimulation. Headphones are placed over the ears and small electrodes are attached with an adhesive to the skin over the neck muscles. Repetitive sounds are transmitted through the headphones and the electrodes record the response of the muscle to the vestibular stimuli.
There are two types of VEMP testing that may be utilized during this type of assessment. They may be done independently or together and can be useful in evaluating for superior semicircular canal dehiscence.
- Cervical VEMP (cVEMP) tests the saccule and inferior nerve response
- Ocular VEMP (oVEMP) tests the utricle and superior nerve response
Vibration induced nystagmus testing (VIN), skull vibration induced nystagmus testing (SVINT), bone conduction vibration – With this testing, a vibrating tuning fork or a battery-operated vibrating device is placed at various points on the head and neck, usually on the mastoid bone, while eye movements are observed.
Videonystagmography (VNG) – Similar to ENG, however with this evaluation eye movements are recorded by an infrared video camera mounted inside goggles that the individual wears instead of sticky-patch electrodes. The testing is generally the same as the caloric vestibular test, optokinetic nystagmus test,
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 5 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Treatment Methods for the treatment of chronic vertigo include, but may not be limited to:
- Intratympanic injection – Medication (usually dexamethasone, gentamicin or methylprednisolone) is delivered directly into the middle ear providing an increased drug concentration to the affected area.
noninvasive techniques are utilized as a treatment for BPPV. Particle repositioning maneuvers include, but are not limited to, the Brandt-Daroff exercises, the Epley maneuver and the Semont maneuver. The theory behind these therapies is that through a series of rotational movements, the particles will be cleared out of the semicircular canals via the common crus of the utricle where they will no longer have an impact on the dynamics of the semicircular canals. All of these maneuvers are generally well tolerated; however, they sometimes cause a migration of debris into the anterior and horizontal canals which cause other variants of positional vertigo.
Transtympanic micropressure – A tympanostomy tube is implanted between the external ear canal and the middle ear. At the time of treatment, an ear cuff is inserted into the external ear canal and a handheld air-pressure generator (connected to a tabletop air-pressure therapy unit) automatically delivers low- frequency, low-amplitude pressure pulses to the middle ear through the tympanostomy tube. One example of a portable device is the Meniett which was developed for the treatment of Meniere’s disease. The device uses positive pressure pulses to the middle ear via the earpiece and ventilation tube to purportedly reduce excess fluid and pressure in the inner ear. Meniett is no longer being manufactured. (Refer to Coverage Limitations section)
Vestibular implant – A unilateral vestibular implant is being investigated as an option to treat vestibular dysfunction. It is comprised of an implanted stimulator, electrode array, and external processor. The stimulator is implanted in the inner ear and delivers electrical pulses to the semicircular canal branches of the vestibular nerve through electrodes. The external processor is comprised of a
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 6 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.
Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Vestibular implant – A unilateral vestibular implant is being investigated as an option to treat vestibular dysfunction. It is comprised of an implanted stimulator, electrode array, and external processor. The stimulator is implanted in the inner ear and delivers electrical pulses to the semicircular canal branches of the vestibular nerve through electrodes. The external processor is comprised of a head-worn unit and a power and control unit. The head-worn unit is held on the scalp by magnets and senses head motion and delivers power and signals across the scalp to the implanted stimulator. The power and control unit sends information to a computer to allow for device setting adjustments and it also monitors the battery level. The device has not been approved by the US Food & Drug Administration (FDA). (Refer to Coverage Limitations section)
- Vestibular rehabilitation – This therapeutic program utilizes exercises to help regain the sense of balance. Specific movements of the head and body are developed for individuals with the intent of reducing or eliminating motion provoked or positional sensitivity.
Coverage Determination
Evaluation Humana members may be eligible under the Plan for the evaluation of chronic vertigo using the following:
- Caloric vestibular testing without recording; OR
- Dynamic or head shaking acuity testing; OR
- Electronystagmography (ENG); OR
- Fistula pressure test; OR
- Head impulse or head thrust test; OR
- Optokinetic nystagmus test; OR
- Positional nystagmus test (Barany or Dix-Hallpike maneuver); OR
- Rotary chair testing; OR
- Saccadic testing; OR
- Spontaneous nystagmus test; OR
- Vibration induced nystagmus testing (VIN), skull vibration induced nystagmus testing (SVINT), bone conduction vibration; OR
- Videonystagmography (VNG)
The above vestibular evaluation techniques are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable.
Humana members may be eligible under the Plan for the evaluation of chronic vertigo using caloric vestibular testing with recording.
Humana members may be eligible under the Plan for the evaluation of suspected or confirmed superior semicircular canal dehiscence using cVEMP and/or oVEMP.
Coverage Limitations
Evaluation Humana members may NOT be eligible under the Plan for the evaluation of chronic vertigo disease using the following:
- Automated combinations of tests (eg, VAT-ENGplus Combo); OR
- Tilt table testing; OR
- Vestibular autorotation testing (VAT)
These are considered experimental/investigational as they are not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.
Humana members may NOT be eligible under the Plan for computerized dynamic posturography (CDP) or dynamic posturography (eg, SMART EquiTest) for any indications. This is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.
Humana members may NOT be eligible under the Plan for cVEMP and/or oVEMP for any indications other than those listed above. This is considered
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 8 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.
Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.experimental/investigational as it is not identified as widely used and generally accepted for any other proposed use as reported in nationally recognized peer- reviewed medical literature published in the English language.
Coverage Determination
Please refer to the member’s applicable pharmacy benefit to determine benefit availability and the terms and conditions of coverage for medication for the treatment of chronic vertigo.
Refer to specific certificate language regarding rehabilitative physical therapy. Most certificates limit the duration or number of visits.
Treatment
Humana members may be eligible under the Plan for the treatment of chronic vertigo using vestibular rehabilitation exercises when the following criteria are met:
- Individual has a confirmed diagnosis of a vestibular disorder (eg, BPPV, Meniere’s disease); AND
- Initial therapy limited to 2 visits with the expectation that the individual will then independently perform exercises in their home setting; AND
- Persistent symptoms for greater than 4 weeks despite medications (eg, antiemetics, antihistamines and benzodiazepines) when medically appropriate and not contraindicated
Humana members may be eligible under the Plan for the treatment of chronic vertigo using particle repositioning maneuvers (eg, Canalith repositioning procedures) when the following criteria are met:
- Individual has had recurrent episodes of positionally triggered vertigo characteristic of BPPV; OR
- Positive finding of BPPV symptoms and characteristic nystagmus with positional testing (eg, Dix-Hallpike test)
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 9 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Humana members may be eligible under the Plan for the treatment of chronic vertigo using intratympanic injection when the following criteria are met:
- Individual has a confirmed diagnosis of a vestibular disorder (eg, BPPV, Meniere’s disease); AND
- Persistent symptoms for greater than 12 weeks despite medical management which includes:
- Medications (eg, antiemetics, antihistamines, benzodiazepines, oral steroids) when medically appropriate and not contraindicated; AND
- Particle repositioning maneuvers; AND
- Vestibular rehabilitation exercises
Coverage Limitations
Treatment Humana members may NOT be eligible under the Plan for vestibular rehabilitation exercises and/or particle repositioning maneuvers for any indications other than those listed above. All other indications are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.
Humana members may NOT be eligible under the Plan for the following for any indications:
- Computerized dynamic posturography (CDP) or dynamic posturography (eg, SMART EquiTest); OR
- Transtympanic micropressure (eg, Meniett); OR
- Vestibular implant
These are considered experimental/investigational as they are not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 10 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.
Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
Additional information about BPPV, chronic vertigo, Menière’s disease, superior semicircular canal dehiscence syndrome and other vestibular disorders may be found from the following websites:
- Background
- National Library of Medicine
- Vestibular Disorders Association
Medical Alternatives
Alternatives to chronic vertigo treatment include, but may not be limited to, the following:
- Dietary modifications
- Reduction of alcohol consumption
Physician consultation is advised to make an informed decision based on an individual’s health needs.
Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.
Provider Claims Codes
| cPT® Code(s) | Description | Comments |
|---|---|---|
| 92270 | ap F Electro-oculography with interpretation and report | Not Covered if used to report any test outlined in Coverage Limitations section |
| 92517 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) | |
| 92518 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP) |
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 11 of 20
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| 92519 | ||
| 92531 | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable | |
| 92532 | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable | |
| 92533 | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable Not Covered if used to report any test outlined in Coverage Limitations section |
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 12 of 20
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Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
| 92534 | Optokinetic nystagmus test | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable |
|---|---|---|
| 92537 | Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations) | |
| 92538 | Caloric vestibular test with recording, bilateral; monothermal (ie, one irrigation in each ear for a total of two irrigations) | |
| 92540 | Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording | |
| 92541 | Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable Not Covered if used to report any test outlined in Coverage Limitations section |
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 13 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
| 92542 | Positional nystagmus test, minimum of 4 positions, with recording | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable Not Covered if used to report any test outlined in Coverage Limitations section |
| 92544 | Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable |
| 92545 | Oscillating tracking test, with recording | Not Covered if used to report any test outlined in Coverage Limitations |
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 14 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.
Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
| 92546 | Sinusoidal vertical axis rotational testing | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable Not Covered if used to report any test outlined in Coverage Limitations section |
|---|---|---|
| 92547 | Use of vertical electrodes (List separately in addition to code for | primary procedure) | Not Covered if used to report any test outlined in Coverage Limitations section |
| 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; | Not Covered |
| 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) | Not Covered |
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 15 of 20
| this is the | current version before utilizing. | |
|---|---|---|
| 92700 | Unlisted otorhinolaryngological service or procedure | Vestibular evaluation techniques outlined in Coverage Determination section are considered integral to the basic vestibular evaluation or office visit and not separately reimbursable Not Covered if used to report any test outlined in Coverage Limitations section |
| 95992 | Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day | |
| 97112 | Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities | |
| CPT® Category Ill Code(s) | Description | Comments |
| 0725T | Vestibular device implantation, unilateral | Not Covered |
| 0726T | Removal of implanted vestibular device, unilateral | Not Covered |
| 0727T | Removal and replacement of implanted vestibular device, unilateral | Not Covered |
| 0728T | Diagnostic analysis of vestibular implant, unilateral; with initial programming | Not Covered |
| 0729T | Diagnostic analysis of vestibular implant, unilateral; with subsequent programming | Not Covered |
| HCPCS Code(s) | Description | Comments |
A4638Replacement battery for patient-owned ear pulse generator, eachNot Covered
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 16 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
| E2120 | Pulse generator system for tympanic treatment of inner ear endolymphatic fluid | Not Covered Device obsolete/No Longer Available |
|---|---|---|
| $9476 | Vestibular rehabilitation program, nonphysician provider, per diem |
References
American Academy of Audiology (AAA). Position statement on the audiologist’s role in the diagnosis and treatment of vestibular disorders.
American Academy of Audiology (AAA). Position statement on the audiologist’s role in the diagnosis and treatment of vestibular disorders. https://www.audiology.org. Published 2005. Accessed July 27, 2023.
American Academy of Neurology (AAN). Assessment: vestibular testing techniques in adults and children (ARCHIVED). https://www.aan.com. Published November 28, 2000. Accessed July 27, 2023.
American Academy of Neurology (AAN). Model Coverage Policy (ARCHIVED). Canalith repositioning procedure (CRP). https://www.aan.com. Published November 2009. Accessed July 27, 2023.
American Academy of Neurology (AAN). Practice guideline: cervical and ocular vestibular evoked myogenic potential testing. https://www.aan.com. Published November 28, 2017. Updated January 30, 2021. Accessed July 27, 2023.
American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Clinical practice guideline: benign paroxysmal positional vertigo (BPPV). https://www.entnet.org. Published March 1, 2017. Accessed July 27, 2023.
American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Clinical practice guideline: Meniere’s disease. https://www.entnet.org. Published April 2020. Accessed July 27, 2023.
American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Position statement: micropressure therapy. https://www.entnet.org. Published March 2008. Updated March 20, 2016. Accessed July 27, 2023.
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 17 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Position statement: posturography. https://www.entnet.org. Published December 27, 2007. Updated September 20, 2014. Accessed July 27, 2023.
American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Position statement: rotational (rotary) chair testing. https://www.entnet.org. Published September 20, 2014. Accessed July 27, 2023.
American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Position statement: vestibular myogenic potential (VEMP) testing. https://www.entnet.org. Published September 20, 2014. Accessed July 27, 2023.
American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Position statement: vestibular rehabilitation. https://www.entnet.org. Published June 24, 1997. Updated October 13, 2020. Accessed July 27, 2023.
Chow M, Ayiotis A, Schoo D, et al. Posture, gait, quality of life, and hearing with a vestibular implant. N Engl J Med. 2021:384(6):521-532. https://www.nejm.org. Accessed May 4, 2022.
ClinicalKey. Crane BT, Minor LB. Peripheral vestibular disorders. In: Flint P, Francis H, Haughey B, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2021:2517-2535.e6. https://www.clinicalkey.com. Accessed July 21, 2023.
ClinicalKey. Lam, W. Syncope. In: Ferri, FF. Ferri’s Clinical Advisor 2024. Elsevier; 2024:1320-1324.e1. https://www.clinicalkey.com. Accessed August 8, 2023.
ClinicalKey. Schleifer J, Sorajja D, Shen W. Syncope. In: Jalife J, Stevenson W. Zipes and Jalife’s Cardiac Electrophysiology: From Cell to Bedside. 8th edition. Elsevier; 2022:1189-1196. https://www.clinicalkey.com. Accessed July 21, 2023.
ClinicalKey. Weinreich HM, Crane BT, Carey JP, et al. Superior semicircular canal dehiscence syndrome. In: Brackmann DE, Shelton C, Arriaga MA.
Chronic Vertigo Evaluation and Treatment
Effective Date: 08/24/2023
Revision Date: 08/24/2023
Review Date: 08/24/2023
Policy Number: HUM-0471-021
Page: 18 of 20
Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.
Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.
- Otologic Surgery. 5th ed. Elsevier; 2023:414-425. https://www.clinicalkey.com. Accessed July 21, 2023.
- ECRI Institute. Hotline Response (ARCHIVED). Dynamic posturography for balance disorders. https://www.ecri.org. Published March 20, 2007. Accessed July 17, 2012.
- ECRI Institute. Hotline Response (ARCHIVED). Transtympanic micropressure treatment for Meniere’s disease. https://www.ecri.org. Published April 18, 2011. Accessed May 15, 2014.
- ECRI Institute. Hotline Response (ARCHIVED). Vestibular autorotation test for evaluating chronic dizziness and imbalance. https://www.ecri.org. Published June 30, 2014. Accessed July 20, 2023.
- ECRI Institute. Hotline Response (ARCHIVED). Vestibular rehabilitation for vestibular dysfunction. https://www.ecri.org. Published June 10, 2010. Accessed July 17, 2012.
- Hayes, Inc. Emerging Technology Report. Multichannel Vestibular Implant (MVI) System for vestibular dysfunction. https://evidence.hayesinc.com. Published June 15, 2023. Accessed July 20, 2023.
- Hayes, Inc. Evidence Analysis Research Brief (ARCHIVED). Computerized dynamic posturography (CDP) for diagnosis of vestibular disorders. https://evidence.hayesinc.com. Published May 6, 2020. Accessed July 27, 2022.
- Hayes, Inc. Evolving Evidence Review. Computerized dynamic posturography for diagnosis of vestibular disorders. https://evidence.hayesinc.com. Published December 7, 2022. Accessed July 20, 2023.
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