CPT® Code 95924

Quick Reference

• Code definition: CPT 95924 covers a combined autonomic reflex screen that tests both cardiovagal (parasympathetic) function and vasomotor adrenergic (sympathetic) function in a single encounter, with passive tilt on a motorized tilt table for at least 5 minutes as a required and definitional component.
• Key billing rule: Report 95924 only when both the parasympathetic battery and the sympathetic adrenergic tilt component are performed together. Separately billing 95921 and 95922 in place of 95924 constitutes unbundling. The MUE is 1 unit per date of service (MAI=3); modifier 59 cannot override this limit [4].
• Modifier essentials: Modifier 26 applies when the physician interprets only and the facility owns the equipment; TC applies to the facility or equipment owner; no modifier is used when the physician performs and interprets in a non-facility setting. Modifiers 50, LT, and RT do not apply.
• Documentation must-have: The report must explicitly state that passive tilt was performed and confirm the duration was at least 5 minutes. Without documented tilt duration, 95924 cannot be supported and 95922 is similarly untenable; the correct fallback is 95921.
• Top confusion point: The most frequent error is reporting 95921 plus 95922 for a combined test with tilt. Per AMA CPT instruction, 95924 subsumes both components and is the only correct code when both are performed together [3].
• Payer alert: CY 2026 OPPS reassigned 95924 to APC 5722, reducing hospital outpatient payment by approximately 29%. Accurate medical necessity documentation is critical for revenue integrity in hospital outpatient settings [1].
• Sudomotor add-on: 95923 (sudomotor testing) is separately reportable alongside 95924 when QSART, thermoregulatory sweat test, or other sudomotor methods are independently performed and separately documented; however, in OPPS, the hospital technical component for 95923 is packaged into the APC payment for 95924 [1].

When to Use This Code

CPT 95924 applies when a provider performs the full combined autonomic reflex screen: the cardiovagal battery (at least 2 of deep breathing with R-R interval recording, Valsalva ratio, or 30:15 ratio) and the vasomotor adrenergic battery (beat-to-beat blood pressure and R-R interval recording during the Valsalva maneuver plus at least 5 minutes of passive tilt) are both completed in the same encounter.

Clinical indications supporting the combined test include:

• Orthostatic hypotension, specifically to differentiate neurogenic from non-neurogenic causes
• Postural orthostatic tachycardia syndrome (POTS) evaluation (G90.A)
• Syncope and presyncope workup where autonomic failure is suspected (R55)
• Peripheral autonomic neuropathies: diabetic, amyloid, autoimmune, and paraneoplastic
• Multiple system atrophy (MSA), Parkinson's disease with dysautonomia, and pure autonomic failure
• Small fiber neuropathy with autonomic involvement

Scope boundaries: 95924 requires a motorized tilt table capable of passive patient positioning; a simple standing test or orthostatic vital sign check does not qualify. The tilt must be passive (the table provides the positional change, not the patient) and must last at least 5 continuous minutes. Beat-to-beat continuous blood pressure monitoring is required for the sympathetic adrenergic component; standard intermittent cuff readings are insufficient.

Provider and setting context: The test is typically performed by neurologists or autonomic specialists in dedicated autonomic laboratories. In a physician office with owned equipment, bill globally without a modifier. In hospital outpatient or independent diagnostic testing facility settings, split billing applies: the interpreting physician bills modifier 26 and the facility bills the technical component.

Code Differentiation Table

The critical differentiator: tilt table use alone does not support 95924. The cardiovagal battery must also be performed and documented. If tilt is performed without the cardiovagal component, report 95922. If the cardiovagal battery is performed without tilt, report 95921.

flowchart TD
    A[Autonomic testing performed] --> B{Cardiovagal battery completed?}
    B -- No --> C{Sympathetic adrenergic with tilt?}
    C -- No --> D[No autonomic code applies]
    C -- Yes --> E[Report 95922]
    B -- Yes --> F{Sympathetic adrenergic with tilt?}
    F -- No --> G[Report 95921]
    F -- Yes --> H[Report 95924]
    H --> I{Sudomotor testing also performed?}
    I -- Yes --> J[Add 95923]
    I -- No --> K[95924 only]

Billing & Modifier Rules

Modifier usage:

Modifier 59 or XU may be necessary when billing 95923 alongside 95924 on the same date to establish that sudomotor testing was a distinct, separately performed service. Without supporting documentation, the additional code may be denied as incidental to the primary service.

Modifiers 50 (bilateral), LT, and RT do not apply; the bilateral indicator is 0 and laterality is not a relevant concept for systemic ANS function testing.

Units and MUE: The MUE value for 95924 is 1 unit per date of service (MAI=3, clinical basis). This cap cannot be circumvented with modifier 59 or any X-modifier; a second unit on the same day will be denied regardless of documentation [4]. The same per-day limit applies to 95921, 95922, and 95923.

OPPS packaging of 95923: In the hospital outpatient setting, 95923 carries an STV-Packaged status, meaning the hospital technical component for 95923 is bundled into the APC 5722 payment for 95924 and cannot be separately billed by the facility. The interpreting physician can still separately bill 95923-26 in split-billing scenarios [1].

Global period: Global days indicator is XXX; the surgical global concept does not apply. No preoperative or postoperative services are bundled into 95924.

Documentation Essentials

The test report must contain specific elements to support 95924. Generic language describing "autonomic testing" is insufficient for audit-proof billing.

Required elements:

• Explicit documentation that passive tilt was performed, with the duration recorded in minutes (must be at least 5 minutes; record the exact duration)
• Beat-to-beat blood pressure tracings and continuous ECG/R-R interval recordings during both the Valsalva maneuver and the tilt portion
• Documentation of at least 2 cardiovagal tests performed: heart rate response to deep breathing with R-R interval, Valsalva ratio calculation, or 30:15 ratio test
• A formal written physician interpretation with findings and clinical correlation; a technician's raw data printout without physician sign-off is not sufficient for professional component billing
• Clinical indication: the ordering diagnosis and relevant symptom history connecting the test to a clinical question

Audit red flags specific to 95924:

• Reports that describe tilt testing but do not specify duration; auditors will downcode to 95921 if tilt duration is absent or ambiguous
• Reports documenting only intermittent cuff blood pressure rather than beat-to-beat continuous tracings; this fails the sympathetic adrenergic component standard
• Professional component claims (modifier 26) where the record contains raw tracings without a dated, signed physician interpretation note
• Billing 95924 when the record documents only the cardiovagal battery with no reference to tilt testing

Medical necessity: The ordering record must reflect symptoms or conditions consistent with autonomic dysfunction. Diagnoses such as G90.A (POTS), G90.3 (neurogenic orthostatic hypotension), E11.43 (Type 2 diabetic autonomic neuropathy), G90.09 (other idiopathic peripheral autonomic neuropathy), or R55 (syncope) with supporting clinical notes constitute adequate medical necessity. Using the deleted code G90.8 (removed effective October 1, 2024) causes an immediate rejection; use G90.89 for non-specific ANS disorders [2].

Medicare, Commercial & Medicaid Payer Rules

Medicare

Physician Fee Schedule (CY 2026): Non-facility global payment is approximately $154.65 (4.63 RVUs at the $33.4009 conversion factor), an increase from CY 2025 ($142.61; 4.41 RVUs at $32.3465) [2] [3].

OPPS CY 2026: Hospital outpatient payment moved to APC 5722 (Level 2 Diagnostic Tests and Related Services), with a geometric mean cost of $281.10, representing approximately a 29% reduction from the prior year APC assignment. CMS finalized this change over provider objections [1]. Claims lacking adequate medical necessity documentation face heightened scrutiny given this payment profile.

Coverage determinations: No National Coverage Determination (NCD) exists for autonomic nervous system testing. Local Coverage Determinations apply in some MAC jurisdictions. Verify active LCD policies via the CMS Medicare Coverage Database and the applicable MAC website for the billing provider's jurisdiction. Common LCD requirements include documented symptoms consistent with autonomic dysfunction.

PC/TC indicator: The split-billing rules for diagnostic tests apply (indicator = 1). CMS requires a formal written interpretation report for the professional component; absence of a dated, signed interpretation note renders the modifier 26 claim unsupportable.

MUE: 1 per date of service (MAI=3) for 95924 and all codes in the 95921 to 95924 family; cannot be overridden [4].

Commercial Payers

Many commercial plans follow Medicare billing rules for autonomic testing, but prior authorization requirements may apply for planned studies in non-emergent settings. Some plans impose diagnosis-driven restrictions requiring a documented autonomic disorder code rather than a symptom-only code to pass automated edits. Verify plan-specific policies for the POTS indication (G90.A); as of FY2023 this code is established, but some commercial plans may lag in updating their automated coverage edits to reflect it.

Medicaid

State-specific Medicaid coverage data for 95924 was not available in the research sources used for this article. Verify authorization requirements and frequency limitations with the applicable state Medicaid program or managed Medicaid plan before billing.

Common Denials & Prevention

Unbundling: 95921 plus 95922 billed separately instead of 95924 Practices billing the component codes separately to capture higher combined payment will trigger NCCI PTP edit denials or post-payment recoupment on audit. AMA CPT instruction expressly states that 95924 is the correct code when both components are performed with tilt [3]. Audit claim output for any date where 95921 and 95922 appear together; file corrected claims replacing both with 95924.

Downcode to 95921 for missing tilt documentation The most common legitimate denial occurs when the test report confirms cardiovagal testing but does not explicitly document that passive tilt was performed for at least 5 minutes. Require that the interpreting physician's report template includes a dedicated field for tilt duration in minutes as a standard element before signing.

Professional component denial for missing interpretation report When billing 95924 with modifier 26 from a hospital setting, the claim requires a dated, signed physician interpretation note in the medical record. Implement a billing hold on professional claims until the interpretation note is confirmed in the EHR.

MUE denial for more than 1 unit Billing more than 1 unit of 95924 on the same date results in an automatic denial; the MAI=3 clinical MUE cannot be overridden by any modifier. Ensure billing systems have a hard stop preventing unit counts above 1 for CPT 95924.

ICD-10-CM rejection for deleted code G90.8 Effective October 1, 2024, G90.8 was deleted and split into G90.81 (serotonin syndrome) and G90.89 (other disorders of ANS). Claims submitted with G90.8 on or after that date reject at front-end payer edits. Update superbills, charge masters, and order sets to G90.89 for non-specific ANS disorder diagnoses.

Coding Scenarios

Scenario 1: Full autonomic reflex screen in a neurology office

A 58-year-old with recurrent syncope and suspected small fiber neuropathy presents for a complete autonomic evaluation. The neurologist performs deep breathing and Valsalva R-R interval testing (cardiovagal), 10 minutes of passive head-up tilt with continuous beat-to-beat blood pressure monitoring (sympathetic adrenergic), and QSART at four limb sites (sudomotor). The neurologist owns the equipment and personally dictates a formal written interpretation.

Correct coding: 95924 (global, no modifier) plus 95923 (global, no modifier); primary diagnosis R55, secondary G90.09

Why: Both parasympathetic and sympathetic adrenergic components with qualifying tilt are complete, so 95924 is the correct combined code. Sudomotor testing was separately performed and documented, supporting 95923. Physician owns equipment in a non-facility setting, so global billing applies.

Scenario 2: Hospital outpatient autonomic lab, split billing

A hospital autonomic lab performs the same combined test on a 67-year-old with Parkinson's disease and neurogenic orthostatic hypotension. The interpreting neurologist signs the report remotely after reviewing the tracings.

Correct coding: Physician bills 95924-26 plus 95923-26; hospital bills 95924-TC; diagnoses G90.3, G20.A

Why: Split billing applies because the facility owns the equipment. In OPPS, 95923 carries STV-Packaged status, so the hospital cannot separately bill 95923-TC; that component is bundled into the APC 5722 payment for 95924. The physician professional component for 95923-26 remains separately billable [1].

Scenario 3: Cardiovagal testing only, no tilt available

A 35-year-old with suspected vagally-mediated syncope undergoes deep breathing, Valsalva, and 30:15 ratio testing at an outpatient neurology clinic that does not have a tilt table.

Correct coding: 95921 (global); diagnosis R55

Why: The at least 5-minute passive tilt required for 95924 and 95922 was not performed. Only the cardiovagal battery was completed. Billing 95924 misrepresents the service and cannot be supported.

Scenario 4: POTS evaluation with correct ICD-10-CM specificity

A 29-year-old with recently confirmed POTS is referred for a baseline autonomic reflex screen. Combined cardiovagal and sympathetic adrenergic testing with an 8-minute tilt is performed; no sudomotor testing is ordered.

Correct coding: 95924 (global or modifier 26/TC per setting); primary diagnosis G90.A

Why: G90.A is the specific code for POTS, added FY2023, and provides the strongest medical necessity support. Using G90.89 or R55 when POTS is confirmed misses the more specific code and may invite medical necessity scrutiny from payers applying diagnosis-driven coverage logic.

Related Codes

• 95921 (CPT): Cardiovagal innervation testing only; the parasympathetic component of 95924 when performed without tilt
• 95922 (CPT): Vasomotor adrenergic testing with tilt only; the sympathetic component of 95924 when performed without the cardiovagal battery
• 95923 (CPT): Sudomotor testing; separately reportable alongside 95924 when independently performed
• G90.A (ICD-10-CM): POTS; primary diagnosis for many 95924 indications added FY2023
• G90.3 (ICD-10-CM): Neurogenic orthostatic hypotension and MSA; common indication
• G90.09 (ICD-10-CM): Other idiopathic peripheral autonomic neuropathy; common indication for idiopathic cases
• E11.43 (ICD-10-CM): Type 2 DM with diabetic autonomic neuropathy; common indication
• R55 (ICD-10-CM): Syncope and collapse; frequent presenting diagnosis for referral

Sources

1. CY 2026 OPPS Final Rule — Federal Register / CMS, November 25, 2025 — CY 2026 OPPS APC assignment for CPT 95924 to APC 5722; 90 FR 53559 to 53560
2. CMS Physician Fee Schedule RVU File CY 2026 (January) — CMS, December 29, 2025 — RVU data, PC/TC indicator, global days, multiple procedure indicator, APC status, and payment amounts for CPT 95921 to 95924
3. CMS Physician Fee Schedule RVU File CY 2025 (January) — CMS, January 2025 — CY 2025 RVU and payment baseline data
4. CMS NCCI MUE Practitioner Services (effective 04-01-2026) — CMS, April 1, 2026 — MUE values and MAI codes for CPT 95921 to 95924 (all 1 per day, MAI=3)