95700
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- For claims using CPT codes not listed in this article, submit supporting clinical and billing documentation for individual review.
- A claim for the prior routine EEG must have been submitted to Medicare with a date of service within 1 year of the ambulatory EEG date of service; documentation/proof of that prior claim must be available.
- When billing only the professional or the technical component, documentation must indicate which component was provided and support billing of that single component.
- The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Key Coverage Criteria
- Ambulatory continuous EEG is covered only if a prior routine “resting” EEG was performed before the ambulatory EEG.
- Routine EEGs covered under this policy are those described by CPT codes 95812, 95813, 95816, 95819, or 95822.
- A routine EEG is defined as a recording of less than a 24-hour continuous duration.
- Ambulatory EEG is covered for diagnostic evaluation when seeking to detect clinical seizures or interictal epileptiform activity.
- Ambulatory EEG is covered for pre-surgical evaluation to localize seizure onset when capture of multiple seizures is needed for surgical planning.
- Ambulatory EEG is covered for routine follow-up monitoring of known seizure disorder or previously identified epileptiform activity.
20 Active Policies
A57030 — Billing and Coding: EEG Ambulatory Monitoring
J06
L33399 — EEG Ambulatory Monitoring
J06
L33693 — Peripheral Venous Ultrasound
J09
A57667 — Billing and Coding: Special EEG Tests
J09
L34521 — Special EEG Tests
Related Codes
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