Digital EEG Spike Analysis

This policy covers digital EEG spike analysis, including topographic voltage and 3D dipole/source localization, when used for pre‑surgical evaluation of members with intractable epilepsy (focal or generalized types and specific syndromes such as Lennox‑Gastaut, absence, juvenile myoclonic, Lafora, epileptic spasms, or unspecified intractable epilepsy). Coverage requires the analysis be performed in conjunction with video EEG long‑term monitoring and involve substantial additional processing/review beyond standard digital EEG (typically ~1 hour technician processing plus 20–30 minutes physician review); it is not medically necessary for routine, ambulatory, or digital‑only EEGs or for non–pre‑surgical indications, and state Medicaid provisions prevail when they conflict.

"Digital EEG spike analysis, including topographic voltage and/or dipole analysis, is medically necessary for pre-surgical evaluation of members with intractable epilepsy when performed in conjuncti..."