Electroencephalogram (EEG) Technologies

Section: Diagnostic Medical
Effective Date: January 01, 2020
Revised Date: January 01, 2020
Last Reviewed: January 22, 2020

Description

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.

Criteria

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:

  • Altered consciousness, such as stuporous, semi-comatose, or comatose states; or
  • Atypical seizure variants in individuals experiencing bizarre, distressing symptoms as seen with “spike and wave stupor” or other forms of seizure disorders; or
  • Head injury, where a subdural hematoma may be identified; or
  • Differentiation of complicated migraine with epilepsy-like symptoms (e.g., auras, alterations in level of consciousness) from true seizure disorders.

Radio and cable telemetry of the EEG may be considered medically necessary for:

  • EEG recording during provocation testing (e.g., withdrawal of anticonvulsant medications), which can be safely undertaken only in the immediate proximity of emergency medical personnel and technology; and
  • EEG recording attempting to localize the seizure focus’ prior to surgery when ambulation is desirable (e.g., when seizures are triggered by specific environmental stimuli or daily events).

Transmission of the EEG by telephone, radio, or cable is considered not medically necessary for any other indication not listed above.

Procedure Codes

95700 95706 95707 95709 95710 97512 95713
95715 95716

Video EEG monitoring may be considered medically necessary for ANY ONE of the following indications and/or conditions:

  • The diagnosis cannot be made by neurological examination, standard EEG studies or ambulatory cassette EEG monitoring; or
  • Routine surface EEG is not diagnostic of a seizure disorder; or
  • Seizure activity is observed clinically but not captured by routine EEG; or
  • Seizure activity captured on routine EEG does not yield sufficient qualitative or quantitative data to determine a treatment regimen; or
  • Antiepileptic drug (AED) withdrawal is needed; or
  • Non-neurological causes of symptoms (e.g., syncope and cardiac arrhythmias) have been ruled out; or
  • To differentiate epileptic events from nonepileptic seizures such as psychogenic seizures; or
  • Individual with intractable epilepsy is being evaluated for surgical intervention; or
  • Seizure monitoring of a neonate or child is needed to develop or modify treatment; or
  • To monitor neonates with hypoxic-ischemic encephalopathy (HIE) who are being treated with therapeutic hypothermia (TH)

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:

  • When used in conjunction with ambulatory electrocardiogram (ECG) recordings for seizures suspected to be of cardiogenic origin; or
  • When used in conjunction with electro-oculogram (EOG) and electromyogram (EMG) recordings for suspected seizures of sleep disturbances; or
  • When used for quantification of seizures in patients who experience frequent absence seizures; or
  • When used in documenting seizures which are precipitated by naturally occurring cyclic events or environmental stimuli which are not reproducible in the hospital or clinic setting; or
  • To monitor neonates with HIE who are being treated with TH.

Twenty-four hour ambulatory cassette-recorded EEGs for any other indication not listed above is considered not medically necessary.

Procedure Codes

95700 95711 95714 95718 95720 95722 95724
95726 99184

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:

  • The surface or long-term EEG is inconclusive and additional testing for possible epileptic spikes or seizures is needed; or
  • Ambulatory recording is needed to facilitate subsequent visual EEG interpretation; or
  • There is need for topographic voltage and dipole analysis in pre-surgical candidates with intractable epilepsy:
    • As continuous monitoring in the operating room for the early detection of an acute intracranial complication during cerebrovascular surgery (i.e., intracranial, carotid endarterectomy); or
    • As monitoring for the detection of nonconvulsive seizures in high risk individuals in the intensive care unit and operating room.

Quantitative electroencephalogram (QEEG) for any other indication not listed above is considered not medically necessary.

Procedure Codes

95955

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.

Procedure Codes

95957

Twenty-four hour ambulatory cassette-recorded EEGs are considered experimental/investigational and, therefore non-covered in the following circumstances:

  • For the study of neonates or unattended, uncooperative individuals; and
  • In localization of seizure focus/foci when the seizure symptoms and/or other EEG recordings indicate the presence of bilateral foci or rapid generalization; and
  • For final evaluation of individuals who are being considered as candidates for resective surgery.

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.

Procedure Codes

95824

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.

Diagnosis Codes

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

F10.11 F11.11 F11.23 F11.93 F12.11 F12.23 F12.93
F13.11 F13.230 F13.231 F13.232 F13.239 F13.930 F13.931
F13.932 F13.939 F14.11 F14.23 F15.11 F15.23 F15.93
F16.11 F17.203 F17.213 F17.223 F17.293 F18.11 F19.11
F19.230 F19.231 F19.232 F19.239 F19.930 F19.931 F19.932
F19.939 G40.001 G40.009 G40.011 G40.019 G40.101 G40.109
G40.111 G40.119 G40.201 G40.209 G40.211 G40.219 G40.301
G40.309 G40.311 G40.319 G40.401 G40.409 G40.411 G40.419
G40.501 G40.509 G40.801 G40.802 G40.803 G40.804 G40.811
G40.812 G40.813 G40.814 G40.821 G40.822 G40.823 G40.824
G40.89 G40.901 G40.909 G40.911 G40.919 G40.A01 G40.A09
G40.A11 G40.A19 G40.B01 G40.B09 G40.B11 G40.B19 G43.101
G43.109 G43.111 G43.119 G43.501 G43.509 G43.511 G43.519
G43.601 G43.609 G43.611 G43.619 P10.0 P90 R40.0
R40.1 R40.2110 R40.2111 R40.2112 R40.2113 R40.2114 R40.2120
R40.2121 R40.2122 R40.2123 R40.2124 R40.2130 R40.2131 R40.2132
R40.2133 R40.2134 R40.2140 R40.2141 R40.2142 R40.2143 R40.2144
R40.2210 R40.2211 R40.2212 R40.2213 R40.2214 R40.2220 R40.2221
R40.2222 R40.2223 R40.2224 R40.2230 R40.2231 R40.2232 R40.2233
R40.2234 R40.2240 R40.2241 R40.2242 R40.2243 R40.2244 R40.2250
R40.2251 R40.2252 R40.2253 R40.2254 R40.2310 R40.2311 R40.2312
R40.2313 R40.2314 R40.2320 R40.2321 R40.2322 R40.2323 R40.2324
R40.2330 R40.2331 R40.2332 R40.2333 R40.2334 R40.2340 R40.2341
R40.2342 R40.2343 R40.2344 R40.2350 R40.2351 R40.2352 R40.2353
R40.2354 R40.2360 R40.2361 R40.2362 R40.2363 R40.2364 R40.2410
R40.2411 R40.2412 R40.2413 R40.2414 R40.2420 R40.2421 R40.2422
R40.2423 R40.2424 R40.2430 R40.2431 R40.2432 R40.2433 R40.2434
R40.2440 R40.2441 R40.2442 R40.2443 R40.2444 R40.3 R40.4
R56.00 R56.01 R56.1 R56.9 S06.5X0A S06.5X0D S06.5X0S
S06.5X1A S06.5X1D S06.5X1S S06.5X2A S06.5X2D S06.5X2S S06.5X3A
S06.5X3D S06.5X3S S06.5X4A S06.5X4D S06.5X4S S06.5X5A S06.5X5D
S06.5X5S S06.5X6A S06.5X6D S06.5X6S S06.5X7A S06.5X8A S06.5X9A
S06.5X9D S06.5X9S

Non-covered Diagnosis codes for Procedure Code 

F90.0 F90.1 F90.2 F90.8 F90.9