Electroencephalography - (0521)

Ambulatory EEG (only after a completed routine EEG) is covered solely for the listed seizure-related indications (e.g., inconclusive routine EEG, suspected epilepsy, sleep‑related seizures, classification for AED selection, exclusion of non‑neurologic causes, seizures only in natural settings, or suspected non‑epileptic events) and is not covered for any other diagnoses; digital EEG spike analysis (CPT 95957) is covered only when performed with an EEG for topographic voltage/dipole analysis in presurgical candidates with intractable (medically refractory) epilepsy and is not covered with routine EEG or for other indications. Key requirements are documentation of a prior routine EEG and clinical justification meeting one of the listed indications, use of the specified ICD‑10/CPT codes, and for CPT 95957 evidence of presurgical candidacy and intractability (failure of ≥2 antiseizure drugs); claims without these will be denied.

"Ambulatory electroencephalography (EEG) following completion of a routine EEG is considered medically necessary for the diagnosis and management of seizure activity when ANY of the following criter..."