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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

95807, 95808, 95810, 95811

Diagnostics 

Diagnosis of Smell & Taste Disorders
Brainstem Auditory Evoked Response (BAER)
Diagnosis & Treatment of Chronic Cerebrospinal Venous Insufficiency (CCSVI) in Multiple Sclerosis
Continuous Recording for Movement Disorders
Diagnosis & Treatment of Bell's Palsy
Chronic Vertigo Evaluation

Computerized

Dynamic

Posturography

(CDP)

Indicates Non-covered Service

Cigna
Humana
Aetna
FloridaBlue
Cigna
FloridaBlue
Electroenceph-alograph (EEG)
EEG - 24 Hour Monitoring
Evoked Potentials, Intraoperative Neurophysiologic Monitoring, & Quantitative Electroenceph-alography (QEEG)
Electrococh-leogram & Perilymphatic Pressure Measurement
Evoked Potentials
Eye Movement Analysis Without Spatial Calibration for Concussion

Neurophysiology Evoked Potentials: SEPs/SERs

Aetna
Humana
Nerve Conduction Testing, Somatosensory & Visual Evoked Potentials, Surface Electromyography
Neurophysiology Evoked Potentials: BAEPs/BAERs
Quantitative electroencephal-ography (QEEG)
Neurophysiology Evoked Potentials: VEPs/VERs
Noninvasive Ear or Pulse Oximetry for Oxygen Saturation
Salivary Hormone Testing

Special EEG Tests

Tympanometry
Vestibular Function Tests
Lung Cancer Screening
Automated Ambulatory Blood Pressure Monitoring (APBM)
Oximetry Monitoring-
Home
Lung Imaging Fluorescence Endoscopy (LIFE)
Oximetry Monitoring-Overnight

Pulmonary Diagnostic Services

Exhaled Breath Tests
Aetna
Humana
FloridaBlue
Humana
Home Spirometry
Total Body Plethysmography
Transtelephonic Spirometry
FloridaBlue
FloridaBlue
Gastrointestinal Manometry
Anorectal Manometry & Electromyography (EMG) of the Urinary & Anal Sphincters
Gastrointestinal Motility Disorders- Diagnosis & Treatment
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis

Ingestible pH & Pressure Capsule

Colorectal Cancer Screening
FloridaBlue
Humana
FloridaBlue
Allergy Testing: Patch testing
Allergy Testing: In vivo testing (skin tests)
Flow Cytometry for Cell Cycle or DNA Analysis
Autonomic Nerve Function Testing
Gait Analysis
Flow Cytometry for Cell Surface, Cytoplasmic, or Nuclear Marker
Electrodiagnostic Testing (EMG/NCV)
Comprehensive Motion Analysis Studies
Aetna
Cigna
FloridaBlue
Humana
Cigna
Nerve Conduction Studies: F-Wave Studies; H-Reflex Studies
Nerve Conduction Studies (NCS) & Electromyography (EMG)
Neurophysiologic Testing & Monitoring
Nerve Conduction Studies
Neuromuscular Junction Testing

Small Fiber Neuropathy Diagnostic Testing

Nerve Fiber Density Testing
Aetna
FloridaBlue
FloridaBlue
UHC
Somatosensory Testing
Vagus Nerve Stimulation (VNS)
Cigna
Humana
Screening for Autism Spectrum Disorders & Rett Syndrome
Psychological & Neuropsychological Tests
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