Mountain State Medical Policy Bulletin
Section: Diagnostic Medical
Number: M-7
Topic: Electronystagmography (ENG) Services
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

The procedures listed below constitute electronystagmography.  Each of these procedures is eligible for payment as a distinct and separate service: 

  1. Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording (92541)
  2. Positional nystagmus test, with recording (92542)
  3. Caloric vestibular test, each irrigation, with recording (92543)
  4. Optokinetic nystagmus test, bidirectional, foveal, or peripheral stimulation, with recording (92544)
  5. Oscillating tracking test, with recording (92545)
  6. Sinusoidal vertical axis rotational testing (92546)

Placing of vertical electrodes (92547) is an inherent part of the ENG.  Therefore, when 92547 is reported with any of the above listed ENG services (92541-92546), the charges will be combined and only the ENG services(s) will be paid.  When reported alone, placement of vertical electrodes (92547) will be denied as a noncovered service.  A participating, preferred, or network provider cannot bill the member separately for the placing of the vertical electrodes.

Description

Electronystagmography involves the electrical recording of movements of the eyes.  It is usually performed in the evaluation of dizziness. 

Procedure Codes

925419254292543925449254592546
92547     

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Also refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

PRN References

12/2003, Placement of vertical electrodes with electronystagmography (ENG) is not covered

References

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Table Attachment

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.