CPT code 95924 – Autonomic nervous system function testing

Key takeaways

CPT Code 95924 reports combined parasympathetic (cardiovagal) and sympathetic adrenergic testing, with at least 5 minutes of passive tilt, in one session.

It replaces 95921 plus 95922 and is never billed with either. Sudomotor testing is not part of 95924, so 95923 can go on the same claim.

The 2026 Medicare national payment is about $154.65, from 4.63 total RVUs, before geographic adjustment.

Coverage follows MAC policy such as LCDs L35124 and L36236. Diabetic autonomic neuropathy (E11.43, E10.43) and autonomic disorders (G90.x) are common pairings.

Pabau’s claims management software pre-fills CPT and ICD-10 codes and submits claims through the Claim.MD clearinghouse for neurology practices.

CPT code 95924 combines cardiovagal and adrenergic testing

CPT Code 95924 reports combined parasympathetic and sympathetic adrenergic autonomic testing, done in one session with at least 5 minutes of passive tilt.

The official descriptor reads: “Testing of autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt.” As CMS billing article A54954 puts it, the code represents those two limbs tested together.

In practice, 95924 bundles two codes that can each be billed alone. The cardiovagal limb is 95921, and the adrenergic limb is 95922. When the same session covers both, 95924 replaces the pair, and CMS says not to report it with either one.

Sudomotor testing sits outside the code. QSART and other sweat tests are billed with 95923, which may appear on the same claim as 95924. So a full autonomic profile with sweat testing is two codes, not one.

The tests behind each limb

Each limb has its own named maneuvers, and the report has to show them. The table maps the standard tests to the code that pays for them.

The tilt is the threshold to watch. If the tilt ran for less than 5 minutes, neither 95922 nor 95924 is met, and only the cardiovagal work can be billed.

CPT 95924 at a glance: The key facts in one table

With the clinical scope settled, these are the administrative facts a biller checks first. Payment figures come from the CMS Physician Fee Schedule for 2026, before geographic adjustment.

95921 vs 95922 vs 95923 vs 95924: Match the code to the tests

Autonomic testing uses four codes, and each one tracks a different part of the nervous system. Picking the wrong one, or stacking codes that can’t be billed together, is the quickest route to a denial.

So the rule is short, and the chart below follows it from the signed report to the code. Cardiovagal plus adrenergic testing is 95924 alone. Add 95923 only when sudomotor testing was also done and documented, and check the current NCCI procedure-to-procedure edits before billing any pairing.

CPT 95922 vs 95924: The pair that shares a tilt

The highest-risk confusion pair is 95922 vs 95924, because both descriptors require at least 5 minutes of passive tilt. A report that shows a tilt and blood pressure tracings can look like either code at a glance.

The difference is the cardiovagal work. 95924 needs the parasympathetic maneuvers as well, so the report must show the deep breathing response and the Valsalva heart rate data. If those results are missing, the study is 95922, and billing 95924 is upcoding.

The opposite mistake costs money. A lab that runs both limbs but bills 95921 and 95922 separately hits the NCCI edit, and the pair is denied. When both limbs are documented, 95924 is the only correct code.

• 95921: Cardiovagal testing only. Deep breathing, Valsalva ratio, or the 30:15 ratio, with at least two of the three.
• 95922: Adrenergic testing only. Beat-to-beat blood pressure during Valsalva and at least 5 minutes of passive tilt.
• 95923: Sudomotor testing. QSART or another sweat test, billable on its own or with 95921 or 95924.
• 95924: Cardiovagal and adrenergic testing together, with at least 5 minutes of passive tilt. Never with 95921 or 95922.

Medical necessity for autonomic function testing: Clinical indications

Medicare and most commercial payers require documented medical necessity before they pay for CPT Code 95924. The indications recognized under LCD L35124 and similar MAC policies center on conditions where autonomic dysfunction is a known complication or the main diagnostic question.

• Diabetic autonomic neuropathy: The most common covered indication. It applies to patients with type 1 or type 2 diabetes who present with unexplained syncope, orthostatic hypotension, or other autonomic symptoms.
• Small fiber neuropathy (SFN): Autonomic testing forms part of the diagnostic workup, often alongside a skin punch biopsy for nerve fiber density.
• Postural orthostatic tachycardia syndrome (POTS): The tilt phase of 95924 records the heart rate rise during head-up tilt that defines the syndrome.
• Unexplained syncope: Testing applies when the cardiac and neurological workup is negative and an autonomic cause is suspected.
• Parkinson’s disease-related autonomic dysfunction: Testing quantifies symptoms such as orthostatic hypotension when they affect treatment.
• Peripheral neuropathy of unknown cause: Testing shows whether autonomic fibers are involved as part of the diagnostic picture.

Commercial payer criteria are often more restrictive than Medicare LCD criteria. Don’t assume a Medicare-covered indication is covered by a commercial plan. Check each payer’s policy before you schedule the study.

ICD-10 codes that support CPT Code 95924 claims

The CMS ICD-10 code set supplies the diagnosis codes that payers check against the indications in their LCDs. Pairing 95924 with a diagnosis that isn’t on the covered list leads to a denial, however strong the clinical record is.

For unexplained syncope, R55 is the usual pairing once the cardiac and neurological workup has come back negative. ICD-10-CM codes update each October.

Verify the codes above against the current-year code set before submission, because an expired code fails the claim regardless of the clinical case. A CPT-to-ICD crosswalk tool helps confirm payer-accepted pairings for 95924 in your MAC jurisdiction.

Medicare coverage and LCDs for autonomic testing

Medicare coverage for CPT Code 95924 comes from Local Coverage Determinations issued by each Medicare Administrative Contractor (MAC). LCD L35124 and LCD L36236 are both in effect. L35124’s billing article is A57551, and L36236’s is A57024. Other MACs publish parallel policies with their own articles, such as A54954 and A57651.

Because LCDs are jurisdiction-specific, confirm which policy your MAC applies in the CMS Medicare Coverage Database. The billing articles carry the coding rules this guide relies on, including the instruction not to report 95924 with 95921 or 95922.

Each MAC receives claims for its own jurisdiction, so a claim sent to the wrong contractor is rejected before anyone reads the report. A medical claims clearinghouse routes each 837P transaction to the right MAC automatically.

Prior authorization requirements by payer

Traditional Medicare does not require prior authorization for CPT Code 95924 when the claim meets LCD criteria. Medicare Advantage plans work differently. Many require prior authorization, and their criteria can be stricter than the LCD.

Commercial payer rules vary by payer and plan year. Check the current requirement before scheduling, through the payer portal or provider services. Thorough insurance eligibility verification at booking shows whether authorization is needed and what the payer wants to see.

A prior authorization request usually needs four things. Include the referring diagnosis with its ICD-10 code and clinical notes on symptoms and prior workup. Add the ordering physician’s statement of medical necessity and the planned tests. Many payers also want proof that simpler steps, such as a cardiac evaluation, came first.

What the report must document

A claim for CPT Code 95924 is only as strong as the record behind it. The chart must show that both the cardiovagal and adrenergic limbs were tested, the results were recorded, and a qualified physician interpreted them.

1. Ordering diagnosis documented: The ordering physician’s diagnosis must be in the record and match a covered ICD-10 code in the applicable LCD.
2. Both limbs recorded: Cardiovagal results with R-R interval data from deep breathing and the Valsalva ratio. Adrenergic results with beat-to-beat blood pressure during Valsalva and a passive tilt of at least 5 minutes, with its duration stated.
3. Test tracings retained: Raw tracings for deep breathing, the Valsalva maneuver, and the tilt must stay in the record for audit. Summary results alone are not enough.
4. Physician interpretation: A written interpretation by a qualified physician, usually a neurologist or autonomic specialist, must be in the record. A technician report does not replace it.
5. Signed and dated report: The interpreting physician must sign and date the report. MACs flag unsigned or undated reports on post-payment review.

If sudomotor testing ran in the same session, document it in its own section of the report so the separate 95923 line is supported. Confirm what makes a clean claim for autonomic testing before your first submission.

Modifiers and place of service

Modifiers tell the payer who did what. These are the ones that come up with 95924.

When one provider performs and interprets the study in the office, bill the global code with no modifier. Place-of-service code 11 covers most office-based testing, while POS 22 applies to an on-campus hospital outpatient lab.

CPT code 95924 reimbursement: 2026 RVUs and Medicare payment

For 2026, 95924 carries 4.63 total RVUs, which works out to about $154.65 nationally. Your locality’s geographic practice cost indices (GPCIs) then move the final payment up or down.

The payment uses the 2026 conversion factor of $33.4009. Because the facility and non-facility totals match, the setting does not change the national rate. Values reset each January 1, so confirm them in the CMS Physician Fee Schedule lookup before quoting expected payment.

Common denial reasons and how to appeal

Denials for CPT Code 95924 cluster around five patterns, and each has its own fix. Review the medical billing denial codes to read the CARC on the remittance before you write an appeal.

Keep a denial log with the CARC, denial date, and fix for each 95924 claim. When the same CARC repeats across dates of service, the fix belongs upstream in the workflow.

Bundling rules and the NCCI edit

CPT Code 95924 is not reported with 95921 or 95922 on the same date. CMS billing article A54954 states it plainly, in line with CPT direction, and NCCI edits enforce it. 95924 already pays for the cardiovagal and adrenergic limbs those two codes describe.

95923 is different. Sudomotor testing is a separate service, and nothing in the CMS guidance stops it from being billed with 95924. Aetna’s policy CPB 0485 says the same: code 95924 does not include sudomotor testing.

Billers often ask whether modifier 59 or XU can unbundle the 95921 or 95922 edit. In a routine autonomic study, it cannot. The modifier needs a distinct session, site, or condition, and testing both limbs together is none of those.

How Pabau keeps CPT 95924 claims clean before they go out

Autonomic testing claims fail on details: a component code typed next to 95924, a diagnosis off the covered list, or a missing authorization number. When those checks happen by hand after the study, each miss means a resubmission and another wait.

Pabau, the practice management platform we build, moves those checks earlier. Its claims software for coders pre-fills the CPT code and ICD-10 diagnoses from the patient record. Built-in CPT and ICD-10 libraries help coders pick 95924, or 95923 alongside it, at the point of service.

For US practices, Pabau submits claims through the Claim.MD clearinghouse. Eligibility checks run before the visit, and remittances post back to the patient record. Your team spends less time re-keying and more time on the few claims that need a person.

Manage autonomic testing claims without the billing headaches

Pabau’s claims management tools support CPT code libraries, 837P submission via Claim.MD, and denial tracking. Your neurology practice spends less time chasing rejections and more time on patient care.

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Conclusion

CPT Code 95924 is a two-limb code, and most errors come from treating it as more or less than that. It pays for cardiovagal and adrenergic testing together, with at least 5 minutes of tilt. It does not pay for sweat testing, which stays on its own 95923 line.

So code from the signed report, not the order. Check that both limbs are documented, drop any 95921 or 95922 line, and keep 95923 where sudomotor testing ran. Book a demo to see how Pabau pre-fills and checks autonomic testing claims before they reach the payer.

Continue your research

Routing claims to the right MAC? Medical claims clearinghouse guide explains how clearinghouse routing reduces MAC-specific submission errors for specialty practices.

Building a denial management process? Revenue cycle management overview covers the end-to-end workflow from eligibility check through final payment posting.

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