Date Issued: 7/30/2019
EmblemHealth has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and in accordance with best practice standards. We will be instituting new payment policies for Electroencephalogram (EEG).
The Electroencephalogram (EEG) is a test that detects abnormalities in brain waves or in the electrical activity of the brain. Electrodes consisting of small discs with thin wires pasted on the scalp detect tiny electrical charges that result from the activity of brain cells.
Based on the American Academy of Neurology, CPT 95957 Digital analysis of EEG (e.g., for epileptic spike analysis) should not be billed with codes for “monitoring for identification and lateralization of cerebral seizure focus.” This service is already included with epileptic spike analysis. Therefore, the following CPT codes should not be billed with 95957:
CPT 95951 Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined EEG and video recording and interpretation (e.g., for presurgical localization), each 24 hours.
CPT 95953 Monitoring for localization of cerebral seizure focus by computerized portable, 16 or more channel EEG, EEG recording and interpretation, each 24 hours, unattended.
CPT 95956 Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, EEG recording and interpretation, each 24 hours, attended by a technologist or nurse.