Tilt Table Testing
© Blue Cross and Blue Shield of Montana
Current Effective Date:
September 24, 2013
Original Effective Date:
September 24, 2013
June 24, 2013
This policy is no longer scheduled for routine literature review and update.
The tilt-table test is used to diagnose neurocardiogenic syncope. The device required for a tilt-table test is a motorized table designed specifically for use in a cardiac catheterization or electrophysiology laboratory. This table differs from tilt-tables used in radiology and physical therapy departments. The tilt-table for syncope testing must change the patient’s position from 0–60º in less than ten seconds, must be able to restore the patient equally quickly to a supine position, and must have proper restraints. The patient is held at a 60° angle for an extended period of time, during which heart rate and blood pressure are monitored and syncope observed should it occur. Syncope is defined as a sudden, transient loss of consciousness, accompanied by loss of postural tone.
The tilt-table test has also been used to classify a patient’s syncope into different categories, which may aid in determining whether a patient is a candidate for insertion of a pacemaker to treat syncope. Based on the heart rate and blood pressure changes observed during the tilt, syncope can be classified as type 1 mixed, type 2A cardioinhibitory, type 2B cardioinhibitory, or type 3 pure vasodepressor.
Prior authorization for tilt table testing is recommended. Call the Blue Cross and Blue Shield of Montana (BCBSMT) Customer Service Department at 1-800-447-7828 or fax your request to the Medical Review Department at 406-441-4624. A retrospective review is performed if services are not prior authorized.
BCBSMT may consider tilt-table testing medically necessary for any of the following:
- Patients who have experienced one or more syncopal episodes, whether or not the medical history is suggestive of neurally mediated (vasovagal) origin, AND
- There is no evidence of structural cardiovascular disease (based on thorough history and physical, 12-lead ECG, echocardiogram and formal exercise testing), OR
- Structural cardiovascular disease is present, but other causes of syncope have been excluded by appropriate testing; OR
- Further evaluation of a patient with syncope in whom an apparent cause has been established (e.g., asystole, atrioventricular block), but in whom demonstration of susceptibility of neurally mediated syncope would affect treatment plans; OR
- Part of the evaluation of exercise-induced or exercise-associated syncope.
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- Tilt-Table Testing for Evaluation of Syncope. Chicago, Illinois: Blue Cross Blue Shield Association – Technology Evaluation Center Assessment Program (1995 June) 10(15): 1-20.
- Benditt, D.G., Petersen, M., et al. Cardiac pacing for prevention of recurrent vasovagal syncope. Annals of Internal Medicine (1995) 122(3):204-9.
- Benditt, D.G., Ferguson, D.W., et al. Tilt table testing for assessing syncope. American College of Cardiology. Journal of the American College of Cardiology (1996) 28(1):263-75.
- Tilt-Table Testing for Evaluation of Syncope. Chicago, Illinois: Blue Cross Blue Shield Association – Technology Evaluation Center Assessment Program (1997 June) 12(7):1-37.
- Linzer, M., Yang, E.H., et al. Diagnosing syncope. Part 2: Unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians. Annals of Internal Medicine (1997) 127(1):76-86.
- Connolly, S.J., Sheldon, R., et al. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. Journal of the American College of Cardiology (1999) 33(1):16-20.
- Sutton, R., Brignole, M., et al. Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope: pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation (2000) 102(3):294-9.
- Brignole, M., Alboni, P., et al. Guidelines on management (diagnosis and treatment) of syncope. European Heart Journal (2001) 22(15):1256-306.
- Klonoff D. Chronic fatigue syndrome and neurally mediated hypotension. JAMA. 1996; 275(5):359-360.
- Tilt Table. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2010 October - Archived) Medicine 2.01.09.
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