Ambulatory EEG with or without video monitoring is considered not medically necessary in all of the following circumstances including, but not limited to: Use in unattended, uncooperative individuals. Localization of seizure focus in individuals with medically refractory epilepsy who are candidates for epilepsy surgery.
Full Answer
Is an ambulatory EEG covered by Medicare?
Oct 01, 2015 · The following indications are not covered as they are not considered medically reasonable and necessary: Study of neonates or unattended, non-cooperative patients; ... The following indications are not covered as they are not considered medically reasonable and necessary: Anxiety; Attention deficit disorder ... “EEG – 24 Hour Monitoring ...
What is the CPT code for 24 hour EEG?
Nov 17, 2019 · Both your physician and the lab or clinic that conducts the EEG must accept Medicare assignment. An ambulatory EEG is covered under Medicare if your physician suspects that you are having seizures, but this has not been proven by a previous standard or sleeping EEG. If you do not have Medicare benefits or another form of health insurance, you may end up …
What is ambulatory or 24-hour EEG?
Sep 12, 2019 · This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Monitoring beyond 72 hours must be supported by written documentation for each additional 24 hours of monitoring and be made available to Medicare upon request. Utilization Guidelines:
How much does an EEG cost without insurance?
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.
Is an EEG covered by Medicare?
What is 24 hour EEG used for?
Why would you need a 48 hour EEG?
What is a 48 hour ambulatory EEG?
What are 10 conditions diagnosed with an EEG?
- Seizure Disorders. The primary use of EEG is diagnosing epilepsy and other seizure disorders. ...
- Sleep Disorders. Sleep disorders range from insomnia to narcolepsy. ...
- Brain Tumors. There are many types of brain tumors. ...
- Brain Injury. ...
- Dementia. ...
- Brain Infections. ...
- Stroke. ...
- Attention Disorders.
How long does it take to read a 24 hour EEG?
What is a 72 hour EEG used for?
What is an extended EEG?
What can an EEG show that an MRI Cannot?
Do you undress for EEG?
What should you not do with an ambulatory EEG?
What is a routine EEG?
Does Medicare cover EEG?
An ambulatory EEG is covered under Medicare if your physician suspects that you are having seizures, but this has not been proven by a previous standard or sleeping EEG. If you do not have Medicare benefits or another form of health insurance, you may end up paying for an EEG exam.
How long does it take to get an EEG?
You stay awake during a standard EEG, it takes no longer than an hour, and there is no preparation necessary beforehand.
What is an EEG?
An electroencephalogram, or EEG, is a non-invasive test that detects and records the brain’s electric activity. Health care providers use EEGs to find brain wave abnormalities caused by trauma, are causing negative health conditions such as seizures. There are three main types of EEGs:
Why do we need EEGs?
Health care providers use EEGs to find brain wave abnormalities caused by trauma, are causing negative health conditions such as seizures. There are three main types of EEGs: Standard EEG testing takes place in the office of your physician, in a clinic, or in a hospital on an outpatient basis. You stay awake during a standard EEG, it takes no ...
What is sleep deprived EEG?
A sleep or sleep-deprived EEG is generally used to detect sleeping disorders, or if more information is needed after a standard EEG has been done. This type of EEG takes place while you are sleeping. Your health care provider may ask you to stay awake the night previous to your test for more accuracy during the exam.
What is an ambulatory EEG?
An ambulatory EEG is a 24-hour EEG that monitors and records brain activity during your daily routine and while you are sleeping. Electrodes are attached to a portable recorder ...
Where does EEG take place?
Standard EEG testing takes place in the office of your physician, in a clinic, or in a hospital on an outpatient basis. You stay awake during a standard EEG, it takes no longer than an hour, and there is no preparation necessary beforehand. A technician applies small metal discs that are connected to wires to your scalp.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for EEG - Ambulatory Monitoring.
ICD-10-CM Codes that Support Medical Necessity
The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the determination.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Does Medicare cover medically necessary services?
Medicare normally covers services deemed medically necessary. According to Medicare.gov, “medically necessary” is defined as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”. In any of those circumstances, ...
Is glaucoma covered by Medicare?
Glaucoma screenings are covered for all beneficiaries with Medicare Part B who have a high risk for glaucoma. Factors that put you at high risk for glaucoma include having diabetes; having a family history of glaucoma; being African American and age 50 or older; and being Hispanic American and age 65 or older.
What is medically necessary?
According to Medicare.gov, “medically necessary” is defined as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”. In any of those circumstances, if your condition produces debilitating symptoms or side effects, ...
Does Medicare cover mammograms?
Intensive behavioral therapy for obesity is covered for all beneficiaries with Medicare Part B who have a body mass index (BMI) of 30 or higher. Mammograms are covered for women with Medicare Part B who are 40 or older; one baseline mammogram is covered for women with Part B between 35 to 39 years old.
Is prostate cancer covered by Medicare?
Prostate cancer screenings are covered for all men with Medicare Part B over age 50, starting the day after their 50th birthday. Screenings for depression. Screenings and behavioral counseling interventions in primary care to reduce alcohol misuse.
What does Medicare cover?
What might this mean for you as a beneficiary? According to the above definition, Medicare covers services that it views as medically necessary to diagnose or treat your health condition. Services must also meet criteria supplied by national coverage determinations and local coverage determinations.
What are reasonable and necessary services?
Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is: 1 Safe and effective. 2 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). 3 Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is: 4 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. 5 Furnished in a setting appropriate to the patient’s medical needs and condition. 6 Ordered and furnished by qualified personnel. 7 One that meets, but does not exceed, the patient’s medical need. 8 At least as beneficial as an existing and available medically appropriate alternative.
What does "appropriate" mean in medical terms?
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.
What is furnished in medical practice?
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.
What does "furnished" mean?
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.
Does Aetna require EEG?
Aetna considers attended electroencephalographic (EEG) video monitoring performed in a healthcare facility medically necessary for the following indications, where the diagnosis remains uncertain after recent (within the past 90 days) neurological examinations and standard EEG studies#N#Footnote 1#N#*, and non-neurological causes of symptoms (e.g., syncope, cardiac arrhythmias) have been ruled out:
How long is an EEG?
Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study greater than 36 hours, up to 60 hours of EEG recording, with video (VEEG)
Is EEG good for seizures?
Furthermore, the American EEG Society has noted that this procedure is widely regarded as safe and effective for evaluating seizures disorders. The American Epilepsy Society has stated that this technique is the method of choice for the evaluation of intractable and/or undiagnosed seizure disorders. Additionally, many studies have reported the usefulness of this technique, and recommended its use for the diagnosis of psychogenic seizures.
What is an EEG test?
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.
What is Medicare Advantage Policy Guideline?
The Medicare Advantage Policy Guideline documents are generally used to support UnitedHealthcare Medicare Advantage claims processing activities and facilitate providers’ submission of accurate claims for the specified services. The document can be used as a guide to help determine applicable:
What to do if your test isn't listed on Medicare?
If your test, item or service isn’t listed, talk to your doctor or other health care provider. They can help you understand why you need certain tests, items or services, and if Medicare will cover them. This lists shows many, but not all, of the items and services that Medicare covers.
Does Medicare cover tests?
Medicare coverage for many tests, items and services depends on where you live. This list only includes tests, items and services that are covered no matter where you live. If your test, item or service isn’t listed, talk to your doctor or other health care provider.
What is TC code?
The TC codes are reported for services provided in a physician office, independent diagnostic testing facility (IDTF), or for services provided in a patient’s home if ordered by a physician’s office or an IDTF.
What is the first step in an audit?
Step two should be a check for national and local coverage determinations (if you are auditing Medicare claims) or coverage policies that may apply to other payer types. When accessing this kind of information, you will find the circumstances for which long-term EEG/VEEG monitoring is deemed medically necessary, as well as some circumstances that may not. Payer policies also usually include a list of covered ICD-10-CM codes.
Services Considered Medically Necessary
Services That Are Not Considered Medically Necessary
- Services that aren’t deemed medically necessary are not covered by Original Medicare, Part A and Part B. It’s possible that some of these services may be covered by a Medicare Advantage plan, but that depends on your specific plan benefits. Non-medically necessary services according to CMS include, but may not be limited to, the following: 1. Times...
Exceptions to The Medically Necessary Requirement
- The following procedures are covered by Medicare if you meet the eligibility criteria for the health-care service. Most of these services are covered under Medicare Part B. If you have a Medicare Advantage plan, also called Medicare Part C, then these services are covered under that plan, as Medicare Advantage plans must cover everything under Part A and Part B. Covered preventive s…