Guide to Autonomic Nervous System Testing CPT Code Problems

autonomic nervous systemANS testing today 

The world of autonomic nervous system testing has been under increasing scrutiny in recent years despite being in existence since the early nineteenth century. The added attention may be due to the significant increase in billable claims from physicians nationwide for automated autonomic nervous system testing or ANS testing.

These increase of claims are not only coming from Neurologists and Cardiologist, but in fact from physicians whose taxonomy and specialty fall squarely outside the realm of being able to properly determine and interpret ANS data and information.  General practitioners, family practice, internal medicine among many others join the ranks of those who are now utilizing and billing all in one comprehensive ANS testing platforms.


Understanding Autonomic Nervous System Testing

Autonomic nervous system testing is a diagnostic procedure used to evaluate the functioning of the autonomic nervous system, which controls involuntary bodily functions such as heart rate, blood pressure, and sweating. This testing is vital in diagnosing various disorders, including autonomic neuropathy, syncope, and autonomic dysfunction.


CPT Code Challenges

One of the primary challenges physicians face is selecting the appropriate CPT code for autonomic nervous system testing. The codes most commonly used are 95921, 95922, and 95923, which represent different types of autonomic testing. However, determining the specific code that accurately reflects the complexity and extent of the testing performed can be complex.


Documentation and Medical Necessity

Accurate documentation and medical necessity are key factors in proper CPT code selection. It is essential for physicians to document the indications for the autonomic nervous system testing and provide a clear rationale for its necessity. This documentation should include relevant patient history, symptoms, and any previous diagnostic findings.


Reimbursement and Compliance

Proper coding and billing are crucial for reimbursement and compliance with regulatory guidelines. Inaccurate coding can result in claim denials or delays in reimbursement. To ensure compliance, physicians should stay updated with the latest coding guidelines and ensure their coding practices align with the requirements set forth by CMS and other payers.


Consulting with Coding Experts

Given the complexities involved in CPT coding for autonomic nervous system testing, many physicians opt to consult with coding experts or engage the services of a trusted medical coding partner. These professionals possess in-depth knowledge of coding guidelines and can offer valuable assistance in selecting the correct CPT codes, optimizing reimbursement, and ensuring compliance.


What do Automated ANS Systems do?

But according to the American Academy of Neurology (AAON), automated testing of ANS systems, in which software generates a report based interpretation of the patient is not yet validated. Most of these automated tests are attempting to evaluate the heart rates response to breathing, Valsalva maneuver, and blood pressure of standing up.

But these data points are considered mostly frivolous, as they measure heart rate response like a snap shot, not a continuous flow. The American Academy of Neurology states it this way, “Many devices are severely limited in the validity of the data they generate because they do not measure or control for expiratory pressure or include beat-to-beat blood pressure measurement, both of which are requirements, not only for scientifically accurate assessment, but also for billing of autonomic testing” (Variations in Methods of Testing P.2)



Accurate CPT coding for autonomic nervous system testing is essential for proper reimbursement and compliance. By understanding the challenges associated with CPT code selection, emphasizing documentation and medical necessity, and seeking expert guidance when necessary, physicians can navigate these complexities effectively. Staying informed and proactive in addressing CPT code problems will streamline the billing process, support accurate reimbursement, and ultimately contribute to providing quality care to patients with autonomic nervous system disorders.


For more information on billable ANS CPT Codes and maximizing your reimbursements please call 954-748-2800 to speak to a specialist.