Does 95721 require prior authorization?

No, 95721 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 95721?

Medicare facility rate: $176.69. Non-facility rate: $218.44. Work RVU: 3.86.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.86

Facility

$176.69

Non-Facility

$218.44

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.

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.

A57030 — Billing and Coding: EEG Ambulatory Monitoring

J06

L33399 — EEG Ambulatory Monitoring

J06

L34521 — Special EEG Tests

J09

L33693 — Peripheral Venous Ultrasound

J09

A57667 — Billing and Coding: Special EEG Tests

Ask Verity about documentation requirements, denial risks, or coverage in your state.