1. Aetna considers tilt table testing, alone or in combination with administration of provocative agents (e.g., isoproterenol), medically necessary for the evaluation of members with recurrent unexplained syncope who have an inconclusive history and physical examination, as well as negative non-invasive tests of cardiac structure and function.

2. Aetna considers the use of tilt table testing experimental and investigational for all other indications, including determining the effectiveness of medications in treating recurrent unexplained syncope, or for identifying chronic fatigue syndrome because there is little support in the peer reviewed medical literature for tilt table testing for these indications.

See also CPB 369 - Chronic Fatigue Syndrome, Diagnosis.

There is sufficient evidence that tilt table testing, with or without isoproterenol, is safe and effective as a diagnostic tool for the evaluation of patients with recurrent unexplained syncope. The reported sensitivity, specificity, and reproducibility of tilt table testing ranged from 65 to 87%, 55 to 96%, and 71 to 88%, respectively. This procedure helps to identify a largely benign disorder and, indirectly, exclude other possibly life-threatening conditions. Tilt table testing performed early in the evaluation may obviate extensive and expensive tests such as intracardiac electrophysiological studies, CAT scan, and MRI of the brain. In contrast, there is insufficient evidence that tilt table testing following intravenous infusion of metoprolol can accurately predict the effectiveness of oral metoprolol therapy in treating patients with recurrent unexplained syncope. This procedure has not been shown to provide any additional information than would have been obtained from a trial of oral therapy.

There is inadequate evidence of the effectiveness of tilt-table testing for identifying chronic fatigue syndrome patients who would respond to medications to increase their blood pressure. Several case series have shown that patients with known CFS frequently have abnormal responses to tilt-table testing, and CFS patients in these series also frequently appear to respond to antihypotensive medications commonly used in patients with neurally mediated hypotension. These case studies fail to demonstrate, however, any value of tilt-table testing in distinguishing CFS patients that would respond to these medications from those who would not.