Vestibular/Ocular Motor Screening (VOMS) 

The Vestibular/Ocular Motor Screening (VOMS) is a brief clinical exam that provokes concussion symptoms through smooth pursuit, saccades, near point of convergence, vestibulo-ocular reflex, and visual motion sensitivity testing. A ≥2-point increase in symptoms on any item, or a near point of convergence distance ≥5 cm, is commonly treated as a positive finding suggesting vestibular or ocular motor impairment.

What VOMS Measures

VOMS is a symptom-provocation exam, not a performance test. It does not measure how well a patient performs a task — it measures whether performing the task provokes concussion symptoms (headache, dizziness, nausea, and fogginess), each rated on a 0–10 scale before and after each item. The exam covers six domains:

• Smooth pursuit — the eyes' ability to track a slow-moving target
• Horizontal and vertical saccades — rapid eye movements between two fixed targets
• Near point of convergence (NPC) — the closest point at which a target can be held in single focus without diplopia, measured in centimeters across three trials
• Horizontal and vertical vestibulo-ocular reflex (VOR) — the reflex that stabilizes gaze during head movement
• Visual motion sensitivity (VMS) — provocation from a full-body turn while visually tracking a target held at arm's length

Because concussion is increasingly understood as a condition with distinct clinical subtypes rather than a single injury pattern, VOMS is used to identify a specific vestibular/ocular motor subtype that behaves differently in recovery and rehab needs from, for example, a predominantly cognitive or migraine-driven presentation.

Administration

VOMS is administered in-office or on the sideline and takes approximately 5–10 minutes. The clinician records a baseline symptom rating before testing begins, then rates headache, dizziness, nausea, and fogginess after each of the six domains. NPC distance is measured directly with a ruler or tape measure across three trials, and the average or worst trial is recorded depending on protocol.

No specialized equipment is required beyond a target (pen, finger, or printed card) and a means of measuring convergence distance, which makes VOMS practical to administer in a standard outpatient visit without scheduling a separate technician session.

Scoring and Interpretation

VOMS does not produce a single total score. Each of the six symptom-provocation domains is scored independently against the patient's own baseline rating, and interpretation is domain-by-domain rather than aggregate:

• Symptom provocation: A ≥2-point increase from baseline in any single symptom category (headache, dizziness, nausea, or fogginess) on any item is commonly treated as a clinically meaningful positive finding for that domain.
• Near point of convergence: An NPC distance of ≥5 cm is commonly considered abnormal and suggests a convergence insufficiency component.

These cutoffs derive primarily from validation work in collegiate athlete populations and generalize with appropriate caution to other ages and settings — a separate pediatric version, VOMS-C, has been developed and validated for children roughly 5–9 years old. VOMS is a screening tool, not a diagnostic instrument on its own; a positive finding is a signal to pursue targeted evaluation or vestibular therapy referral, not a standalone diagnosis.

Clinical Use Case

VOMS is most useful for:

• Concussion subtyping — distinguishing a vestibular/ocular motor-predominant presentation from other concussion clinical trajectories (cognitive, migraine, anxiety/mood, or cervicogenic)
• Rehab referral targeting — a positive VOMS finding is a common trigger for referral to vestibular therapy or ocular motor rehabilitation rather than general "rest and reassess"
• Serial monitoring — repeat administration across the recovery window can help track whether vestibular/ocular symptoms are resolving, plateauing, or worsening, informing return-to-play and return-to-learn decisions
• Complementing performance-based screens — VOMS is frequently used alongside the SAC, BESS, and King-Devick test as part of a broader sideline or office concussion battery, since each tool captures a different clinical dimension

Billing Context

VOMS sits outside the standard neuropsychological/psychological testing CPT family (96116–96146). Because it is a brief clinical maneuver rather than a formal psychometric test administration, it is typically captured within the evaluation and management (E/M) encounter itself rather than billed as a separate line item. In some physical medicine or physical therapy contexts, elements of a vestibular/ocular exam may be reflected in evaluation codes outside the neurocognitive testing family — this varies by setting and payer, and practices should verify current guidance with their Medicare Administrative Contractor (opens in a new tab) or payer policy rather than assuming a specific code applies. For the neurocognitive and RTM codes that typically do apply to concussion follow-up care, see CPT 96116 and the RTM 98978 code used for between-visit monitoring.

Where VOMS Sits in the Kavera Protocol

VOMS is part of Kavera's Concussion module, where symptom-provocation findings are captured alongside the broader concussion battery — including PCSS symptom tracking and headache-specific instruments like HIT-6 — to build a longitudinal picture of recovery between clinic visits rather than relying solely on point-in-time office findings.

How Kavera Handles This

VOMS is part of the first-visit vestibular exam and every re-evaluation. Kavera records symptom provocation per item and near-point convergence so vestibular findings sit beside PCSS and cognitive scores, and at-home vestibular work assigned between visits is tracked against it. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials.

FAQ

What is considered a positive VOMS result?

A positive result is generally a ≥2-point increase in symptom severity (headache, dizziness, nausea, or fogginess) from baseline on any single item, or a near point of convergence distance of ≥5 cm. Each domain is interpreted individually rather than combined into one total score.

How is VOMS different from the King-Devick test?

King-Devick measures rapid number-naming speed as a proxy for oculomotor and attentional function, comparing completion time to the patient's own baseline. VOMS instead measures symptom provocation across six vestibular and ocular motor domains and does not produce a timed performance score.

Can VOMS be billed separately from an office visit?

VOMS is typically bundled into the evaluation and management encounter rather than billed as a standalone code, since it functions as a brief clinical exam maneuver rather than a formal psychometric test administration. Coverage and billing treatment vary by setting and payer.

Is there a pediatric version of VOMS?

Yes. VOMS-C is a modified version validated for children roughly 5–9 years old, reflecting that standard VOMS symptom-provocation cutoffs were developed primarily in collegiate athlete populations.

How often should VOMS be repeated during recovery?

There is no single fixed interval; many protocols repeat VOMS at follow-up visits to track whether vestibular/ocular symptoms are trending toward resolution, informing decisions along the return-to-play criteria and vestibular rehab pathway.