Revenue Cycle Insider

New code set makes test coding far more specific.

The AMA has announced the final CPT^® 2027 code set, and there’s big news for neurology coders: There will be revisions to the four major autonomic nerve system function testing codes, as well as new codes to choose from for the tests.

This could have a major impact on your code choices, as the new codes will mean new options for certain tests. You’ll also want to make sure your documentation for these services stays sharp, as the code descriptors are more explicit in their interpretation and report requirements.

Check out this guidance on how the current autonomic nerve system function testing codes will change, what the new codes will look like, and how to adjust your reporting when CPT^® 2027 becomes effective on January 1.

CPT^® Revises 4 Current Codes

The four major autonomic nerve system function testing codes have all been revised. Here are the codes as they will appear in 2027 (added material in bold and underlined):

• 95921 (Testing of autonomic nervous system function, with interpretation and report; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio)
• 95922 (Testing of autonomic nervous system function, with interpretation and report; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least 5 minutes of passive tilt (ie, tilt table))
• 95923 (Testing of autonomic nervous system function, with interpretation and report; sudomotor, quantitative sudomotor axon reflex test (QSART) or silastic sweat imprint)
  • Code 95923 is a more detailed revision, as it also deletes “including 1 or more of the following” and “thermoregulatory sweat test, and changes in sympathetic skin potential.
• 95924 (Testing of autonomic nervous system function, with interpretation and report; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt (ie, tilt table))

Impact: Clearly, there is an emphasis on interpretation and report in 2027. “I would describe the interpretation and report addition [to the code descriptors] as clarifying requirements to prevent inappropriate reporting,” explains Dawnelle Sager, CPC, CPMA, CRC, AAPC Approved Instructor, senior consultant at Pinnacle Enterprise Risk Consulting Services. “As the April 2025 AMA/Specialty Society Relative Value Scale (RVS) Update Committee (RUC) meeting minutes indicate, CPT^® previously issued guidance to address miscoding of autonomic testing, and the 2027 revisions appear to continue that effort while specifically clarifying the interpretation and report requirement.”

The provider’s interpretation of the results should include whether the findings are normal or abnormal, and any relevant limitations. “The report should meet the requirements of each code descriptor, along with any applicable CPT^® guidelines or payer policies,” says Sager. “In general, the report should include:

• “The testing procedures the physician performed and
• “The data generated for each procedure at each site, when applicable.”

Based on the April 2025 RUC meeting minutes, CPT^® added the “interpretation and report” language to prevent reporting these services when the interpretive work is not performed, which also includes reliance on automated device interpretations. Sager cited CPT^® Assistant (June 2008), which states, “testing results lead to interpretation. Reports are the work product of the interpretation of test results.” 

So, a statement such as “reviewed and agree with the interpretation,” by itself, does not appear to demonstrate that the provider independently evaluated the testing data and performed the required interpretation, says Sager. 

New Codes Mean Reporting Adjustments Are Necessary

The codes above will be joined by a slew of new autonomic nervous system function testing codes. Here’s a list of the new codes:

• +95944 (Testing of autonomic nervous system function, with interpretation and report; use of tilt table (List separately in addition to code for primary procedure))
  • This code is for use with 95921 and 95947 only.
• 95945 (Testing of autonomic nervous system function, with interpretation and report; sudomotor, thermoregulatory sweat test)
• 95946 (… sudomotor, assessing the sympathetic skin response (SSR) potential)
• 95947 (… combined parasympathetic and sudomotor testing, quantitative sudomotor axon reflex test (QSART) or silastic sweat imprint)
• 95948 (… combined sympathetic adrenergic with at least 5 minutes of passive tilt (ie, tilt table) and sudomotor testing, quantitative sudomotor axon reflex test (QSART) or silastic sweat imprint)
• 95949 (… combined parasympathetic, sympathetic adrenergic function with at least 5 minutes of passive tilt (ie, tilt table), and sudomotor testing, quantitative sudomotor axon reflex test (QSART) or silastic sweat imprint)

Impact: “Coders will need to identify the specific testing methods performed and select the appropriate individual or combination code,” Sager advises. “Currently, 95923 includes several testing methods. In 2027, QSART [quantitative sudomotor axon reflex test] and silastic sweat imprint will remain under 95923, but thermoregulatory sweat testing and sympathetic skin response testing will have separate codes. Based on April 2025 RUC meeting minutes, 95923 currently groups several technically different testing methods under one code. The revised structure separates these methods to allow reporting of specific testing performed.”

In short: QSART and silastic sweat imprint testing will remain under 95923, while thermoregulatory sweat testing moves to 95945 and sympathetic skin response testing moves to 95946.

Take This Advice on New Testing Codes

To prepare for autonomic nerve system function testing in 2027, Sager offers the following tips:

• Verify payer coverage and billing policies for the new and revised codes
• Educate providers on the code changes
• Update coding tools and documentation templates to reflect the changes
• Review the entire revised autonomic testing code family, including the new codes
• Review CPT^® parenthetical instructions and applicable bundling edits before reporting individual tests together or adding the tilt-table code
• Base code selection on the specific testing methods performed and whether the functions were tested individually or together
• Confirm documentation supports all required components includes the provider’s interpretation and report.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC