cpt code and description
95812 – Electroencephalogram (EEG) extended monitoring; 41-60 minutes -average fee payment- $350 – $360
95813 – Electroencephalogram (EEG) extended monitoring; greater than 1 hour
95816 – Electroencephalogram (EEG); including recording awake and drowsy
95819 – Electroencephalogram (EEG); including recording awake and asleep
95822 – Electroencephalogram (EEG); recording in coma or sleep only
95827 – Electroencephalogram (EEG); all night recording
95950 – Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic (eg, 8 channel EEG) recording and interpretation, each 24 hours – $330 – $360
95951 – Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (eg, for presurgical localization), each 24 hours
95953 – Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended
An electroencephalogram (EEG) is a diagnostic test that measures the electrical activity of the brain (brainwaves) using highly sensitive recording equipment attached to the scalp by fine electrodes. It is used to diagnose neurological conditions.
This LCD addresses EEG testing via 24 hour ambulatory cassette recording.
Ambulatory EEG should always be preceded by a routine EEG. A routine EEG is described by CPT codes 95812, 95813, 95816, 95819, 95822 or 95827 and refers to a routine EEG recording of less than a 24 hour continuous duration.
Ambulatory EEG monitoring is a diagnostic procedure for patients in whom a seizure diathesis is suspected but not defined by history, physical or resting EEG. Twenty four hour ambulatory cassette-recorded EEGs offer the ability to record the EEG on a long-term, outpatient basis. Electrodes for at least four (4) recording channels are placed on the patient. The cassette recorder is attached to the patient’s waist or on a shoulder harness. Recorded electrical activity is analyzed by playback through an audio amplifier system and video monitors.
Ambulatory EEG monitoring may facilitate the differential diagnosis between seizures and syncopal attacks, sleep apnea, cardiac arrhythmias or hysterical episodes. The test may also allow the investigator to identify the epileptic nature of some episodic periods of disturbed consciousness, mild confusion, or peculiar behavior, where resting EEG is not conclusive. It may also allow an estimate of seizure frequency, which may at times help to evaluate the effectiveness of a drug and determine its appropriate dosage.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
Ambulatory EEG monitoring
Q: What is the difference between 95816 (EEG recording including awake and drowsy) and code 95819 (EEG recording including awake and asleep)?
A: The answer is that to use 95819 the patient must have fallen asleep and if not 95816 should be used. However, the line between drowsy and asleep can often be difficult to determine and it is permissible to use 95819 if a sleep study was intended, but, despite the best efforts of the technician, sleep was not obtained.
Q: What is the minimum number of channels or electrodes to be used in order to report codes 95812, 95813, 95955 and 95822?
A: One has to meet the minimum technical standards for an EEG test, not only with a minimum of 20 minutes of monitoring, but with a minimum of eight channels and other rules as set forth by national organizations such as the American Clinical Neurophysiology Society.
Q: When should I not use Code 95957? When do I use Code 95957?
A: Code 95957 should not be used simply when the EEG was recorded digitally. There is no additional charge for turning on an automated spike and seizure detector on a routine EEG, ambulatory EEG, or video-EEG monitoring. Nor is there an additional code for performing EEG on a digital machine instead of an older generation analog machine. Some features of digital EEG make it easier and quicker to read, and other features slow it down by providing new optional tricks and tools. Overall, it is about the same amount of work as an analog EEG.
Code 95957 is used when substantial additional digital analysis was medically necessary and was performed, such as 3D dipole localization. In general, this would entail an extra hour’s work by the technician to process the data from the digital EEG, and an extra 20-30 minutes of physician time to review the technician’s work and review the data produced. Most practitioners would not have the opportunity to do this advanced procedure. It would be more commonly used at specialty centers, e.g. epilepsy surgery programs. Note that the codes for “monitoring for identification and lateralization of cerebral seizure focus” already include epileptic spike analysis.
Ambulatory electroencephalogram (EEG) testing in the outpatient setting (e.g., at home) is a diagnostic test used to evaluate an individual in whom a seizure disorder is suspected but not conclusively confirmed by the person’s medical history, physical examination, and a previous routine or standard (awake and asleep) EEG.
It is the policy of health plans affiliated with Centene Corporation that ambulatory EEG is considered not medically necessary for studies of unattended, non cooperative patients.
Ambulatory EEG (CPT code 95950 or 95953) should always be preceded by an awake and drowsy/sleep EEG (CPT code 95816, 95819, 95822 or 95827).
Correspondence Language Policy/Example Number 14.00000 – Misuse of column two code with column one code
For example, CPT code 95956 describes “Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse”. When EEG monitoring is performed during anesthesia for an intracranial procedure (CPT code 00210), reporting this monitoring separately with CPT code 95956 is a misuse of CPT code 95956. Intraoperative EEG monitoring is integral to anesthesia services for intracranial procedures. Therefore CPT code 95956 is not reported separately with CPT code 00210.
Correspondence Language Policy/Example Number 4.90000 – Mutually exclusive procedures
For example, CPT codes 95953 and 95956 describe different types of EEG monitoring for localization of cerebral seizure focus. CPT code 95953 describes monitoring by computerized portable electroencephalography (16 or more channel EEG), and CPT code 95956 describes monitoring by cable or radio, 16 or more channel telemetry. Since both methods of EEG monitoring would not be utilized in the same 24-hour period, the two procedures are mutually exclusive of one another.
Correspondence Language Policy/Example Number 2.A-V – HCPCS/CPT procedure code definition
For example, the code descriptor for HCPCS code G0398 is “Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation”, and the code descriptor for CPT code 93041 is “Rhythm ECG, 1-3 leads; tracing only without interpretation and report”. Based upon the code descriptors an ECG is a component of the home sleep study test. Therefore, CPT code 93041 is bundled into HCPCS code G0398.
Stereotaxic depth electrode implantation is covered prior to surgical treatment of focal epilepsy for patients who are unresponsive to anticonvulsant medications has been found both safe and effective for diagnosing resectable seizure foci that may go undetected by conventional scalp EEGs.
Electroencephalographic (EEG) monitoring is covered during surgical procedures involving the cerebral vasculature.
Ambulatory or 24 hour EEG (paper or digital interpretation) is covered for patients in whom a seizure diathesis is suspected but not defined by history, physical or resting EEG.
Ambulatory EEG can be utilized in the differential diagnosis of syncope and transient is chemic attacks if not elucidated by conventional studies
* Ambulatory EEG should always be preceded by an awake and asleep resting EEG. Digital EEG interpretation EEG techniques are considered established in
a. Epilepsy: For screening for possible epileptic spikes or seizures in long-term EEG monitoring recording to facilitate subsequent expert visual EEG interpretation
b. Operating Room (OR) and Intensive Care Unit (ICU) monitoring: For continuous EEG monitoring by frequency-trending to detect early, acute intracranial complications in the OR or ICU, and for screening for possible epileptic seizures (convulsive or non convulsive) in high-risk ICU patients
Electroencephalographic (EEG) Monitoring: Technique used in the assessment of gross cerebral blood flow during general anesthesia. EEG monitoring as an indirect measure of cerebral perfusion requires the expertise of an electroencephalographer, a neurologist trained in EEG, or an advanced EEG technician for its proper interpretation.
• Inconclusive routine “resting” EEGs;
• Experiencing episodic events where epilepsy is suspected but the history, examination, and routine EEG recordings do not resolve the diagnostic uncertainties;
• Patients with confirmed epilepsy who are experiencing suspected non-epileptic events or for classification of seizure type (only ictal recordings can reliably be used to classify seizure type (or types) which is important in selecting appropriate anti-epileptic drug therapy;
• Differentiating between neurological, cardiac, and psychiatric related problems;
• Localizing seizure focus for enhanced patient management;
• Identifying and medicating absence seizures;
• For suspected seizures of sleep disturbances;
• Seizures which are precipitated by naturally occurring cyclic events or environmental stimuli which are not reproducible in the hospital or clinic setting.
Ambulatory monitoring, however, is not necessary to evaluate most seizures, which are usually readily diagnosed by routine EEG studies and history. Medicare anticipates that many of these outpatient studies will not provide the diagnosis within the first 24 hours, but expects that 48 hours of monitoring will be diagnostic in most circumstances. Ambulatory monitoring beyond 48 hours frequently produces poor data in the period after 48 hours as electrode contact may no longer be optimal after 48 hours. Occasionally patients may require an additional 48 hour monitoring period to establish a diagnosis which is usually performed at a later date. Medical necessity must be documented for review in these circumstances. This 48-hour limitation does not apply to the inpatient setting where patients are frequently withdrawn from their anti-epileptic regimens, and where precise pre-surgical localization of epileptic foci is often conducted.
It is anticipated that once the diagnosis has been established, this study will not be repeated for the same diagnosis, nor will it be used in the monitoring of a therapeutic regimen. Again, this expectation will not be applied to patients readmitted for inpatient care of their seizure disorder.
LIMITATIONS (NON-COVERED INDICATIONS):
• Study of neonates or unattended, non-cooperative patients;
• Localization of seizure focus/foci when the seizure symptoms and/or other EEG recordings indicate the presence of bilateral foci or rapid generalization.
Generalized nonconvulsive epilepsy
Generalized convulsive epilepsy
Epilepsy and recurrent seizures
Partial epilepsy and epileptic syndromes with complex partial seizures
Partial epilepsy and epileptic syndromes with simple partial seizures
Epilepsia partialis continua
Other forms of epilepsy and recurrent seizures
Stokes-Adams syndrome (syncope with heart block)
Syncope and collapse
Post traumatic seizures