Neurology & Pain Management Coding Alert

Question: I am having a terrible time getting my ANSAR tests paid by Medicare. I’m filing with 95943 and Medicare denies for medical necessity. Is there a better code to use? 

Florida Subscriber 

Answer: ANSAR (Autonomic Nervous System And Respiration) evaluates the balance between the nervous system (stress) and heart function.  The CPT® code 95943 (Simultaneous, independent, quantitative measures of both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during rest, paced [deep] breathing, Valsalva maneuvers, and head-up postural change) does seem to be a reasonable code for ANSAR testing, and is sometimes recommended for the procedure.  Your provider’s documentation would need to support both the sympathetic and parasympathetic function testing was performed as identified by the code’s descriptor.

Many Medicare contractors have local coverage policies for Autonomic Function Testing, which include the criteria for coverage for these diagnostic tests.  Some commercial payers might accept 95943, but others consider ANSAR testing to be experimental and investigational. Aetna, for example, “considers ANSAR (ANX 3.0) test experimental and investigational in the evaluation of paradoxical parasympathetic syndrome because its clinical value has not been established,” according to its policy number 0485.  If a payer takes this stance, you won’t be reimbursed for the service. Practices should review the patient’s insurance coverage for this type of diagnostic testing. The patient should be notified of non-coverage prior to the testing being performed.