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An EEG is a recording of the electrical current potentials spontaneously from nerve cells in the brain onto the skull. Variations in wave characteristics correlate with neurological conditions and are used to diagnose conditions.
Transmission of the EEG by telephone, radio, or cable may be considered medically necessary when the closest medical facilities are located in remote areas which lack trained EEG interpreters for individuals with the following indications:
Radio and cable telemetry of the EEG may be considered medically necessary for:
Transmission of the EEG by telephone, radio, or cable is considered not medically necessary for any other indication not listed above.
Video EEG monitoring may be considered medically necessary for ANY ONE of the following indications and/or conditions:
Video EEG monitoring for any other indication not listed above is considered not medically necessary.
Note: Monitoring may be performed on an outpatient or inpatient basis, depending on the frequency and duration of seizure activity and length of time necessary to collect data. Individuals with frequent (at least three per week) intractable minor seizures and those individuals being evaluated for efficacy of drug treatment can be evaluated on an outpatient basis, in three (3) to 12 hours. Inpatient monitoring is required for individuals such as those with seizures that only occur at night, are infrequent, are clinically severe (such as prolonged complex partial seizures), or are provoked by drug withdrawal.
Twenty-four hour ambulatory cassette-recorded EEGs may be medically necessary in the following circumstances:
Twenty-four hour ambulatory cassette-recorded EEGs for any other indication not listed above is considered not medically necessary.
Quantitative electroencephalogram (QEEG) may be considered medically necessary when used as an adjunct to traditional EEG and/or diagnostic evaluation of epilepsy when ANY ONE of the following criteria is met:
Quantitative electroencephalogram (QEEG) for any other indication not listed above is considered not medically necessary.
Digital analysis of electroencephalogram (DEEG) is considered not medically necessary as there is no evidence that such additional processing and interpretation has been shown to improve outcomes in individual management.
Twenty-four hour ambulatory cassette-recorded EEGs are considered experimental/investigational and, therefore non-covered in the following circumstances:
Scientific evidence does not demonstrate the efficacy of twenty-four hour ambulatory cassette-recorded EEGs in certain instances.
Telephone transmission of the EEG to determine electrocerebral silence, i.e., brain death, is considered experimental/investigational, and therefore non-covered. Scientific evidence does not support its use in these instances.
Quantitative electroencephalographic-based assessment (QEEG) is considered experimental/investigational and, therefore non-coveredwhen usedas a diagnostic aid for attention deficit/hyperactivity disorder. Scientific evidence does not support its use as a diagnostic aid for this condition.
Covered Diagnosis Codes for Procedure Codes: 95700, 95706, 95707, 95709, 95710, 97511, 97512, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726, 95955, and 99184.
Non-covered Diagnosis codes for Procedure Code
Not Applicable
Internal Medical Policy Committee 1-22-2020 adding codes
Internal Medical Policy Committee 1-19-2021 Coding update-added Diagnosis Codes: F10.130, F10.131, F10.132, F10.139, F10.930, F10.931, F10.932, F10.939, F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132, F19.139
References (PDF)
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.
Covered Diagnosis Codes for Procedure Codes 95700, 95706, 95707, 95709, 95710, 95712, 97511, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726, 95955 and 99184