Ambulatory Electroencephalography

Aetna considers ambulatory EEG, with or without home video, medically necessary to classify seizure type when routine EEG is equivocal, to diagnose suspected epilepsy when history/exam and routine EEG (including negative provocative measures) are inconclusive, and to localize epileptogenic regions for presurgical evaluation, provided the member has had a neurologic exam and standard EEG within the past 12 months. Ambulatory EEG is investigational for all other indications, is usually sufficient within 48 hours (monitoring >7 days may be reviewed for medical necessity), and CPT codes are covered only if the stated selection criteria/documentation are met.

"ICD-10 codes covered if selection criteria are met: P90 (Convulsions of newborn)."

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