Medical Policies - Medicine


Quantitative Sensory Testing

Number:MED205.030

Effective Date:10-15-2017

Coverage:

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Quantitative sensory testing (QST), including but not limited to current perception threshold testing, pressure-specified sensory device testing, vibration perception threshold testing, and thermal threshold testing, is considered experimental, investigational and/or unproven.

Description:

Quantitative sensory testing (QST) systems are used for the noninvasive assessment and quantification of sensory nerve function in patients with symptoms of or the potential for neurologic damage or disease. Pain conditions evaluated may include diabetic neuropathy and uremic and toxic neuropathies, complex regional pain syndrome, carpal tunnel syndrome, and other nerve entrapment/compression disorders or damage.

Quantitative sensory testing has been investigated for a broad range of clinical applications, including evaluation of peripheral neuropathies, detection of carpal tunnel syndrome, spinal radiculopathy, evaluation of the effectiveness of peripheral nerve blocks, quantification of hypoesthetic and hyperesthetic conditions, and differentiation of psychogenic from neurologic disorders.

QST systems measure and quantify the amount of physical stimuli required for sensory perception to occur in the patient. As sensory deficits increase, the perception threshold of QST will increase, which may be informative in documenting progression of neurologic damage or disease. QST has not been established for use as a sole tool for diagnosis and management but has been used in conjunction with standard evaluation and management procedures (e.g., physical and neurologic examination, monofilament testing, pinprick, grip and pinch strength, Tinel’s sign and Phalen’s and Roos’ test) to enhance the diagnosis and treatment-planning process and confirm physical findings with quantifiable data. Stimuli used in QST includes touch, pressure, pain, thermal (warm and cold), or vibratory stimuli.

The criterion standard for evaluation of myelinated large fibers is the electromyographic nerve conduction study (EMG-NCS). However, the function of smaller myelinated and unmyelinated sensory nerves, which may show pathologic changes before the involvement of the motor nerves, cannot be detected by nerve conduction studies. Small fiber neuropathy has traditionally been a diagnosis of exclusion in patients who have symptoms of distal neuropathy and a negative nerve conduction study.

Depending on the type of stimuli used, QST can assess both small and large fiber dysfunction. Touch and vibration measure the function of large myelinated A-alpha and A-beta sensory fibers. Thermal stimulation devices are used to evaluate pathology of small myelinated and unmyelinated nerve fibers; they can be used to assess heat and cold sensation, as well as thermal pain thresholds. Pressure-specified sensory devices (PSSD) assess large myelinated sensory nerve function by quantifying the thresholds of pressure detected with light, static, and moving touch. Finally, current perception threshold testing involves the quantification of the sensory threshold to transcutaneous electrical stimulation. In current perception threshold testing, typically 3 different frequencies are tested: 5 Hz, designed to assess C fibers; 250 Hz, designed to assess A-delta fibers; and 2,000 Hz, designed to assess A-beta fibers. Results are compared with those of a reference population.

Because QST combines the objective physical sensory stimuli with the subject patient response, it is psychophysical in nature and requires patients who are alert, able to follow directions, and cooperative. In addition, to get reliable results, examinations need to be standardized with standardized instructions to the patients, and stimuli must be applied in a consistent manner by trained staff. Psychophysical tests have greater inherent variability, making their results more difficult to standardize and reproduce.

Regulatory Status

A number of quantitative sensory testing (QST) devices have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. They include devices for current perception threshold testing (e.g., Medi-Dx 7000® Current Perception Threshold; Neuro Diagnostic Associates), pressure-specified sensory testing (e.g., NK Pressure-Specified Sensory Device™; NK Biotechnical), vibration testing (e.g., Vibration Perception Threshold meter; Xilas Medical), and thermal testing (e.g., Thermal Sensory Analyzer, TSA and TSA-II; Medoc Corp., Israel).

Rationale:

This medical document was originally created in 2002 and has been updated regularly with searches of the MEDLINE database. Most recently, the literature was searched through October 9, 2015. Following is a summary of the key literature to date.

Literature was reviewed on the various types of quantitative sensory testing (QST) for which there are U.S. Food and Drug Administration (FDA)?approved devices. This includes current perception threshold testing, pressure-specified sensory device (PSSD) testing, vibration perception threshold testing, and thermal threshold testing.

For each device, answers to the following questions were sought in the literature:

What is the technical performance of QST? (i.e., test-retest values, interoperator variability)

What is the diagnostic performance of QST? (i.e., sensitivity and specificity of QST compared with conventional tests, using appropriate reference standards and conducted in appropriate populations)

What is the clinical utility of QST i.e., does QST change patient management or improve the net health outcome compared with standard testing?

In addition, systematic reviews and meta-analysis that evaluated studies using more than 1 type of QST were assessed.

Systematic Reviews

A 2013 systematic review by Grosen et al. identified 14 studies that evaluated the association between QST findings and analgesic response. (1) One study was conducted in healthy volunteers, 9 in surgical patients, and 4 in chronic pain patients. Study findings were not pooled but were discussed by patient population. The authors reported that all studies of surgical patients were observational cohort studies, and none reported analgesic response as a primary outcome. Six of the 9 studies found a correlation between QST measurement (electrical, pressure, and/or thermal stimulation) and consumption of analgesics. The article did not report whether the correlation was for all, or only some, of the outcomes related to analgesic consumption. The 4 studies on chronic pain patients were conducted as part of clinical drug trials, and QST was conducted at baseline before treatment. Two studies found a correlation between QST parameters and at least 1 analgesic response outcome. The authors concluded that the scientific evidence was not sufficiently robust to determine whether QST parameters are predictors of response to analgesic treatment.

Current Perception Threshold Testing

Technical Performance

In 1999, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) published a technology review of the Neurometer® device. (2) Much of the literature compared the results of Neurometer® testing with nerve conduction studies (NCSs) in patients with known disease. In many instances, the results of the Neurometer® testing demonstrated more numerous or pronounced abnormalities than NCSs, a finding consistent with the hypothesis that abnormalities of small nerve fibers precede those of large nerve fibers tested in NCSs. However, this observation could also be related to the fact that the Neurometer® tests multiple sites with 3 different frequencies and that any identified abnormality is considered significant. AANEM’s assessment concluded the following on the technical performance of current perception devices:

“Reference values need to be established for well-characterized and representative populations.

Reproducibility and interoperator variability of the Neurometer® CPT [current perception threshold] normal values need to be established and expressed statistically in control subjects and patients with specific diseases.”

In 2002, Yamashita et al. evaluated current perception thresholds using the Neurometer® by comparing findings in 48 patients with lumbar radiculopathy and 11 healthy controls. (3) The authors reported finding significantly higher current perception threshold values in the affected legs of patients with lumbar radiculopathy at 2000-, 250-, and 5-Hz frequencies than in the unaffected legs. Current perception threshold values in the affected legs were also significantly higher in control subjects at 2000- and 250-Hz frequencies but not significantly different at 5 Hz. The authors concluded that current perception threshold testing may be useful in quantifying sensory nerve dysfunction in patients with radiculopathy. However, this study did not establish standardized normal values or evaluate the reproducibility of QST measurements.

Diagnostic Performance

Limited published evidence is available on diagnostic performance. Several studies have compared current perception threshold testing with other testing methods, but sensitivity and specificity have not been reported. For example, in 2012, Ziccardi et al. evaluated 40 patients presenting with trigeminal nerve injuries involving the lingual branch. (4) Patients underwent current perception threshold testing and standard clinical sensory testing. Statistically significant correlations were found between findings of electrical stimulation testing at 250 Hz and the reaction to pinprick testing (p=0.02), reaction to heat stimulation (p=0.01), and reaction to cold stimulation (p=0.004). In addition, significant correlations were found between electrical stimulation at 5 Hz and the reaction to heat stimulation (p=0.017), reaction to cold stimulation (p=0.004), but not the reaction to pinprick testing (p=0.096).

In addition, in 2001 Park et al. compared current perception threshold testing with standard references for thermal sensory testing and von Frey tactile hair stimulation in a randomized, double-blind, placebo- controlled trial with 19 healthy volunteers. (5) All current perception threshold measurements showed a higher degree of variability than thermal sensory testing and von Frey measurements but there is some evidence that similar fiber tracts can be measured, especially C-fiber tract activity at 5 Hz, with current perception threshold, thermal sensory, and von Frey testing methods. This study only included healthy volunteers.

Clinical Utility

No comparative studies evaluating the impact of current perception testing on patient management decisions or health outcomes were identified.

A study published in 2009 used the Neurometer device in subjects with hand-arm vibration exposure. (6) The primary purpose of the study was to evaluate the utility of a staging scale (Stockholm Sensorineural Scale), not to determine the accuracy of quantitative sensory testing, so it did not provide evidence on the clinical utility of current perception testing.

Pressure-Specified Sensory Testing (PSSD)

Technical Performance

No published studies were identified.

Diagnostic Performance

Standard evaluation and management of patients with potential nerve compression, disease, or damage consists of physical examination techniques and may include Semmes-Weinstein monofilament testing and, in more complex cases, nerve conduction velocity (NCV) testing. Several studies have compared performance of these tests with PSSD. For example, a 2000 study by Weber et al. evaluated the sensitivity and specificity of PSSD and NCV testing in 79 patients, including 26 healthy controls. (7) The NCV test had a sensitivity of 80% and a specificity of 77%; the PSSD had a sensitivity of 91% and a specificity of 82%. The difference between the 2 tests was not significantly different.

A 2010 study by Nath et al. evaluated 30 patients with winged scapula and upper trunk injury and 10 healthy controls. (8) They used the FDA-cleared PSSD by Sensory Management Services to measure the minimum perceived threshold in both arms for detecting 1-point static (1PS) and 2-point static (2PS) stimuli. The authors used a published standard reference threshold value for the dorsal hand first web (DHFW) skin and calculated threshold values for both the DHFW and the deltoid using the upper limit of the 99% normal confidence interval (CI). No published threshold values were available for the deltoid location. PSSD testing was done on both arms of all participants, and electromyography (EMG) testing only on the affected arms of symptomatic patients. Using calculated threshold values, patients with normal EMG results had positive PSSD results on 50% (8/16) of 1PS deltoid, 71% (10/14) of 2PS deltoid, 65% (11/17) of 1PS DHFW, and 87% (13/15) of 2PS DHFW tests. Study findings suggested that PSSD is more sensitive than needle EMG in detecting brachial plexus upper trunk injury. These findings should be confirmed, and the thresholds used to categorize a PSSD finding as positive for the deltoid should be validated further.

A 2013 systematic review by Hubscher et al. evaluated the relation between QST and self-reported pain and disability in patients with spinal pain. (9) Twenty-eight of 40 studies identified used PSSD. The overall analysis found low or no correlations between pain thresholds, as assessed by QST and self-reported pain intensity or disability. For example, the pooled estimate of the correlation between pain threshold and pain was -0.15 (95% CI, -0.18 to -0.11) and between pain threshold and disability was -0.16 (95% CI, -0.22 to -0.10). The findings suggested that QST provides low accuracy for diagnosing patients’ level of spinal pain and disability.

Clinical Utility

No clinical trials identified demonstrated that use of the PSSD resulted in changes in patient management or improved patient outcomes. In 2012, Suokas et al. published a systematic review of studies evaluating QST in painful osteoarthritis; most studies used pressure testing. (10) The authors did not report finding any studies that evaluated the impact of QST on health outcomes.

Vibration Testing

Technical Performance

A multicenter, industry-funded study compared vibration threshold testing (CASE IV, biothesiometer, C64 graduated tuning fork) with standard NCSs in 195 (86% follow-up) subjects with diabetes mellitus. (11) Tests were performed independently by trained technicians; all standard nerve conduction evaluations were sent to a central reading center. Intraclass correlation coefficients (ICCs) for the tests ranged from 0.81 to 0.95, indicating excellent to highly reproducible results. Correlation coefficients for the various vibration QST instruments were moderate at -0.55 (CASE IV vs tuning fork) to 0.61 (CASE IV vs biothesiometer). In contrast, the ICC between CASE IV and a composite score for nerve conduction was low (r=0.24). These results indicate that vibration threshold testing could not replace standard nerve conduction testing but might provide a complementary outcome measure.

Diagnostic Performance

In 2010, a study from India evaluated 100 patients with type 2 diabetes using a vibration perception threshold device (Sensitometer; Dhansai Lab). Manufactured in Mumbai, the device is not FDA- approved. (12) The authors reported sensitivities and specificities for the device and standard NCSs. For vibration testing, a positive finding (i.e., presence of neuropathy) was defined as patients reporting of no vibration sensation at a voltage of more than 15 V. According to NCSs, 70 of 100 patients had evidence of neuropathy. Vibration perception thresholds had a sensitivity of 86% and a specificity of 76%. Semmes-Weinstein monofilament testing, which was also done, had a higher sensitivity than vibration testing (98.5%) and a lower specificity (55%). Finally, a diabetic neuropathy symptom score determined by responses to a patient questionnaire, had a sensitivity of 83% and a specificity of 79%. The authors commented that the simple neurologic examination score appeared to be as accurate as vibration testing. The Sensitometer is not available in the United States, and it is not known how similar this device is to FDA-approved vibration threshold testing devices.

Clinical Utility

No clinical trials identified demonstrated that use of vibration testing resulted in changes in patient management or improved patient outcomes.

Thermal Testing

Technical Performance

A 2012 systematic review by Moloney et al. examined the literature on the reliability of thermal QST. (13) A total of 21 studies met the review’s inclusion criteria (using an experimental design, assessing reliability, comparing thermal QST with other methods of assessment, testing at least twice). The investigators used a quality appraisal checklist to evaluate the reliability of the studies identified. Only 5 of the 21 studies were considered to be high quality. The review authors found considerable variation in the reliability of thermal QST; this included the 5 studies considered to be of high quality. The authors also noted several methodologic issues that could be improved in future studies, including better description of raters and their training, blinding and randomization, and standardization of test protocols. A 2015 study by Vuilleumier et al. evaluated reliabilityof QST in a low back pain population; it included thermal QST using an FDA-approved device by Medoc. (14) A total of 89 patients participated in 2 QST sessions conducted at least 7 days apart. The median of 3 thermal perception trials on the first day was compared with the median on the second day (between-session reliability). Several measures of reliability were reported (i.e., coefficient of variability [CV]), ICC, coefficient of reliability). The reliability of heat pain detection and tolerance at the arm and leg were considered to be acceptable, with between-session CVs ranging from 1.8% to 6.1%. However, cold pain detection at the arm or leg did not have acceptable reliability, with between-session CVs ranging from 44% to 87%.

Diagnostic Performance

In 2008, Devigili et al. published a study on 150 patients referred for suspected sensory neuropathy and tested with a Medoc thermal perception-testing device. (15) Patients underwent (1) clinical examination, including spontaneous and stimulus-evoked pain, (2) a sensory and motor nerve conduction study, (3) warm and cooling thresholds assessed by QST, and (4) skin biopsy with distal intraepidermal nerve fiber (IENF) density. Based on the combined assessments, neuropathy was ruled out in 26 patients; 124 patients were diagnosed with sensory neuropathy and, of these, 67 patients were diagnosed with small nerve fiber neuropathy. Using a cutoff of 7.63 IENF/mm at the distal leg (based on the 5th percentile of controls), 59 patients (88%) were considered to have abnormal IENF (small nerve fiber) density. Only 7.5% of patients had abnormal results for all 3 examinations (clinical, QST, skin biopsy), 43% of patients had both abnormal skin biopsy and clinical findings, and 37% of patients had both abnormal skin biopsy and QST results. The combination of abnormal clinical and QST results was observed in only 12% of patients. These results indicated that most patients evaluated showed an IENF density of less than 7.63 together with either abnormal spontaneous or evoked pain (clinical examination) or abnormal thermal thresholds (QST). The authors of this study recommended a new diagnostic “gold standard” based on the presence of at least 2 of 3 abnormal results (clinical, QST, IENF density).

Clinical Utility

No clinical trials identified that use of thermal testing resulted in changes in patient management or improved patient outcomes. A 2014 study by Ahmad et al. addressed how QST might be used in practice, although it did not directly study clinical utility. (16) The study was prospective and included 124 opioid-naive patients scheduled for abdominal myomectomy or hysterectomy. Patients underwent preoperative thermal QST, conducted by the same investigator. Tests included warm and cold sensation in which patients activated a button as soon as they felt a temperature change. Tests also included warm and cold pain modalities in which the button was pressed when pain thresholds were reached.

The primary outcome was morphine use in the 24 hours after surgery. Intravenous morphine was administered postsurgery such that an individual’s pain level rated less than 4 on a 0-to-10 scale; pain was assessed on arrival and every 6 hours thereafter. In addition, a patient-controlled analgesia system was used to deliver morphine in the first 24 hours. Preoperative heat and cold pain thresholds correlated significantly with 24-hour morphine consumption. Patients with initial heat pain thresholds and cold pain thresholds above the median used more morphine (median, ≥19 mg, p=0.004). The authors stated that findings could be used to stratify patients preoperatively based on their baseline thermal QST scores and to manage patients more or less aggressively, depending on their QST test findings. Because the study did not prospectively manage patients and opioid administration was individualized; it is not clear how management would differ if QST scores had been incorporated in the management strategy.

Ongoing and Unpublished Clinical Trials

A search of ClinicalTrials.gov in October 2015 did not identify any ongoing or unpublished trials that would likely influence this review.

Summary of Evidence

The evidence for quantitative sensory testing (QST) in patients who have conditions associated with nerve damage or disease (e.g., diabetic neuropathy, carpal tunnel syndrome) includes several studies on technical accuracy and diagnostic performance. Relevant outcomes are test accuracy and validity, other test performance measures, and functional outcomes. The studies do not adequately address the reproducibility of test results and reference values in normal populations. In addition, there is a lack of evidence on diagnostic accuracy compared with conventional testing; therefore it is not possible to conclude whether the use of QST impacts patient management or improves patient functioning. The evidence is insufficient to determine the effects of the technology on health outcomes.

Practice Guidelines and Position Statements

European Federation of Neurological Societies

In 2010, the European Federation of Neurological Societies updated its guidelines on neuropathic pain assessment. (17) The guidelines state:

“Quantitative sensory testing (QST) can be used in the clinic along with bedside testing to document the sensory profile. Because abnormalities have often been reported in non-NPs [neuropathic pain] as well, QST cannot be considered sufficient to separate differential diagnoses (GPP) [good practice point, i.e., consensus recommendation]. QST is helpful to quantify the effects of treatments on allodynia and hyperalgesia and may reveal a differential efficacy of treatments on different pain components (Level A). To evaluate mechanical allodynia/hyperalgesia, the task force recommends the use of simple tools such as a brush and at least 1 high-intensity weighted pinprick or von Frey filament (e.g., 128 mN). The evaluation of pain in response to thermal stimuli is best performed using the computerized thermotest, but the task force does not recommend the systematic measure of thermal stimuli except for pathophysiological research or treatment trials. A simple and sensitive tool to quantify pain induced by thermal stimuli in clinical practice is still lacking.”

American Academy of Neurology

A 2003 report (reaffirmed 2008) from the American Academy of Neurology (AAN) concluded that QST is probably (level B recommendation) an effective tool in documenting of sensory abnormalities and in documenting changes in sensory thresholds in longitudinal evaluation of patients with diabetic neuropathy. (18) Evidence was weak or insufficient to support the use of QST in patients with other conditions (small fiber sensory neuropathy, pain syndromes, toxic neuropathies, uremic neuropathy, acquired and inherited demyelinating neuropathies, or malingering).

American Association of Neuromuscular & Electrodiagnostic Medicine

The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) published a technology literature review on QST (light touch, vibration, thermal, pain) in 2004. (19) The review concluded that QST is a reliable psychophysical test of large- and small-fiber sensory modalities but is highly dependent on the full patient cooperation. Abnormalities do not localize dysfunction to the central or peripheral nervous system, and no algorithm can reliably distinguish between psychogenic and organic abnormalities. The AANEM technology review also indicated that QST has been shown to be reasonably reproducible over a period of days or weeks in normal subjects, but, for individual patients, more studies are needed to determine the maximum allowable difference between 2 QSTs that can be attributed to experimental error.

In 2005, AANEM with AAN and American Academy of Physical Medicine & Rehabilitation developed a formal case definition of distal symmetrical polyneuropathy based on a systematic analysis of peer- reviewed literature supplemented by consensus from an expert panel. (20) QST was not included as part of the final case definition, given that the reproducibility of QST ranged from poor to excellent, and the sensitivities and specificities of QST were found to vary widely among studies.

Contract:

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coding:

Effective July 1, 2005, the following CPT codes were introduced for quantitative sensory testing:

0106T using touch pressure stimuli,

0107T using vibration stimuli,

0108T using cooling stimuli,

0109T using heat-pain stimuli,

0110T using other stimuli.

NOTE: This series of codes describes "psychophysical" testing of subjective feelings of sensation to assess endocrine and neurological disorders such as neuropathies. These tests are more complex and standardized than physical examination services. QST is performed in the office or outpatient setting by physicians such as internists, geriatricians, family practitioners, neurologists, and endocrinologists. The codes are "per extremity" so as many as four units per code could be submitted. Previously these tests would have been coded using the unlisted code, 95999. (These stimuli are not electrical like those used in current perception threshold testing - G0255).

In the past, providers may have used CPT code 95904 or codes 95925-95927 for current perception threshold testing. When CPT code 95904 was used, some providers may also have used the modifier 52 (reduced service) to reflect the fact that no latency study was performed. However, the current perception threshold test is not accurately described by either 95904 or 95925-95927. There is a HCPCS code (G0255) specific to this test. Another distinction between a nerve conduction test and the current perception threshold test is that the former is performed in a laboratory setting, while the latter is performed in an office setting.

Effective 12/31/12, code 95904 was deleted. Codes 95907-95913 might now be incorrectly reported for these services.

CODING:

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

CPT/HCPCS/ICD-9/ICD-10 Codes

The following codes may be applicable to this Medical policy and may not be all inclusive.

CPT Codes

0106T, 0107T, 0108T, 0109T, 0110T

HCPCS Codes

G0255

ICD-9 Diagnosis Codes

Refer to the ICD-9-CM manual

ICD-9 Procedure Codes

Refer to the ICD-9-CM manual

ICD-10 Diagnosis Codes

Refer to the ICD-10-CM manual

ICD-10 Procedure Codes

Refer to the ICD-10-CM manual


Medicare Coverage:

The information contained in this section is for informational purposes only. HCSC makes no representation as to the accuracy of this information. It is not to be used for claims adjudication for HCSC Plans.

The Centers for Medicare and Medicaid Services (CMS) does have a national Medicare coverage position.

A national coverage position for Medicare may have been changed since this medical policy document was written. See Medicare's National Coverage at <http://www.cms.hhs.gov>.

References:

1. Grosen K, Fischer IW, Olesen AE, et al. Can quantitative sensory testing predict responses to analgesic treatment? Eur J Pain. May 8 2013; 17(9):1267-80. PMID 23658120

2. Technology review: the Neurometer Current Perception Threshold (CPT). AAEM Equipment and Computer Committee. American Association of Electrodiagnostic Medicine. Muscle Nerve. Apr 1999; 22(4):523-31. PMID 10204790

3. Yamashita T, Kanaya K, Sekine M, et al. A quantitative analysis of sensory function in lumbar radiculopathy using current perception threshold testing. Spine (Phila Pa 1976). Jul 15 2002; 27(14):1567-70. PMID 12131719

4. Ziccardi VB, Dragoo J, Eliav E, et al. Comparison of current perception threshold electrical testing to clinical sensory testing for lingual nerve injuries. J Oral Maxillofac Surg. Feb 2012; 70(2):289-94. PMID 22079068

5. Park R, Wallace MS, Schulteis G. Relative sensitivity to alfentanil and reliability of current perception threshold vs von Frey tactile stimulation and thermal sensory testing. J Peripher Nerv Syst. Dec 2001; 6(4):232-40. PMID 11800047

6. House R, Krajnak K, Manno M, et al. Current perception threshold and the HAVS Stockholm sensorineural scale. Occup Med (Lond). Oct 2009; 59(7):476-82. PMID 19460876

7. Weber RA, Schuchmann JA, Albers JH, et al. A prospective blinded evaluation of nerve conduction velocity versus Pressure-Specified Sensory Testing in carpal tunnel syndrome. Ann Plast Surg. Sep 2000; 45(3):252-7. PMID 10987525

8. Nath RK, Bowen ME, Eichhorn MG. Pressure-specified sensory device versus electrodiagnostic testing in brachial plexus upper trunk injury. J Reconstr Microsurg. May 2010; 26(4):235-42. PMID 20143301

9. Hubscher M, Moloney N, Leaver A, et al. Relationship between quantitative sensory testing and pain or disability in people with spinal pain-a systematic review and meta-analysis. Pain. Sep 2013; 154(9):1497-504. PMID 23711482

10. Suokas AK, Walsh DA, McWilliams DF, et al. Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. Jul 11 2012; 20(10):1075-85. PMID 22796624

11. Kincaid JC, Price KL, Jimenez MC, et al. Correlation of vibratory quantitative sensory testing and nerve conduction studies in patients with diabetes. Muscle Nerve. Dec 2007; 36(6):821-7. PMID 17683081

12. Mythili A, Kumar KD, Subrahmanyam KA, et al. A Comparative study of examination scores and quantitative sensory testing in diagnosis of diabetic polyneuropathy. Int J Diabetes Dev Ctries. Jan 2010; 30(1):43-8. PMID 20431806

13. Moloney NA, Hall TM, Doody CM. Reliability of thermal quantitative sensory testing: a systematic review. J Rehabil Res Dev. Apr 2012; 49(2):191-208. PMID 22773522

14. Vuilleumier PH, Biurrun Manresa JA, Ghamri Y, et al. Reliability of quantitative sensory tests in a low back pain population. Reg Anesth Pain Med. Nov-Dec 2015; 40(6):665-673. PMID 26222349

15. Devigili G, Tugnoli V, Penza P, et al. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain. Jul 2008; 131(Pt 7):1912-25. PMID 18524793

16. Ahmad S, De Oliveira GS, Jr., Bialek JM, et al. Thermal quantitative sensory testing to predict postoperative pain outcomes following gynecologic surgery. Pain Med. May 2014; 15(5):857-64. PMID 24517836

17. Cruccu G, Sommer C, Anand P, et al. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol. Aug 2010; 17(8):1010-8. PMID 20298428

18. American Academy of Neurology. Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Available at <http://www.neurology.org>. Accessed July 30, 2015.

19. Chong PS, Cros DP. Technology literature review: quantitative sensory testing. Muscle Nerve. May 2004; 29(5):734-47. PMID 15116380

20. England JD, Gronseth GS, Franklin G, et al. Distal symmetrical polyneuropathy: definition for clinical research. Muscle Nerve. Jan 2005; 31(1):113-123. PMID 15536624

21. Centers for Medicare and Medicaid Services (CMS). National Coverage Determination (NCD) for sensory Nerve Conduction Threshold Tests (sNCTs) (160.23). Available at <https://www.cms.gov>. Accessed July 30, 2015.

22. Quantitative Sensory Testing. Chicago, Illinois: Blue Cross and Blue Shield Association Medical Policy Manual. (2015 November) Medicine 2.01.39.

Policy History:

Date Reason
10/15/2017 Reviewed. No changes.
4/15/2016 Document updated with literature review. Coverage unchanged.
4/15/2015 Reviewed. No changes.
9/15/2014 Document updated with literature review. Coverage unchanged.
11/15/2013 Document updated with literature review. The following stimuli testing were added to the experimental, investigational and unproven statement: vibration perception threshold testing, and thermal threshold testing.
5/15/2011 Document updated with literature review. Coverage unchanged.
8/15/2009 Revised and updated policy with literature review; remains experimental, investigational and unproven.
9/15/2007 Revised/Updated Entire Document
11/1/2005 MP Converted from Bulletin
11/1/2002 New Medical Policy

Archived Document(s):

Title:Effective Date:End Date:
Quantitative Sensory Testing07-15-202108-14-2022
Quantitative Sensory Testing01-15-202107-14-2021
Quantitative Sensory Testing09-15-202001-14-2021
Quantitative Sensory Testing09-15-201909-14-2020
Quantitative Sensory Testing01-15-201909-14-2019
Quantitative Sensory Testing10-15-201701-14-2019
Quantitative Sensory Testing04-15-201610-14-2017
Quantitative Sensory Testing04-15-201504-14-2016
Quantitative Sensory Testing09-15-201404-14-2015
Quantitative Sensory Testing11-15-201309-14-2014
Quantitative Sensory Testing05-15-201111-14-2013
Quantitative Sensory Testing08-15-200905-14-2011
Quantitative Sensory Testing09-15-200708-14-2009
Quantitative Sensory Testing11-01-200509-14-2007
Current Perception Threshold Testing08-01-200210-31-2005
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