Commercial

Medical Policy

Title:

Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home

Policy #:

07.03.25a

Policy

INPATIENT MONITORING

Video electroencephalogram (EEG) monitoring in the inpatient setting is considered medically necessary and, therefore, covered for any of the following indications:

EEG recording during withdrawal of antiseizure medications, which can be safely undertaken only in the immediate proximity of emergency medical personnel and technology
EEG recording attempting to localize the seizure focus prior to surgery
EEG recording after a negative ambulatory EEG and continuing episodes of suspected seizure activity

HOME MONITORING

Ambulatory EEG monitoring with or without video in the home setting is considered medically necessary and, therefore, covered when any of the following criteria are met:

To evaluate inconclusive routine “resting” EEGs
To evaluate the occurrence of episodic events where epilepsy is suspected but the history, examination, and routine EEG recordings do not resolve the diagnostic uncertainties
To evaluate the occurrence of suspected nonepileptic events in an individual with confirmed epilepsy or for classification of seizure type (only ictal recordings can reliably be used to classify seizure type [or types], which is important in selecting appropriate antiepileptic drug therapy)
To differentiate between neurological, cardiac, and psychiatric related disorders
To localize seizure focus for enhanced management
To identify and medicate absence seizures
To evaluate the occurrence of suspected seizures of sleep disturbances
To evaluate seizures that are precipitated by naturally occurring cyclic events or environmental stimuli that are not reproducible in the hospital or clinic setting

All other uses for ambulatory EEG monitoring and video EEG monitoring are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the diagnosis of illness or injury.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

BILLING REQUIREMENTS

Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, continuous electroencephalogram (EEG) monitoring is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are numerous devices approved by the FDA for EEG monitoring.

Description

An electroencephalogram (EEG) is a diagnostic test that measures the electrical activity of the brain (brainwaves) using highly sensitive recording equipment attached to the scalp by fine electrodes. It is used to diagnose neurological conditions.

EEGs can be recorded by 24-hour ambulatory cassette or digital recorders and offer the ability to record the EEG on a long-term outpatient basis. Ambulatory EEG monitoring is accomplished by a recorder that continuously records brain wave patterns during 24 hours of an individual’s routine daily activities and sleep. The monitoring equipment consists of an electrode set, preamplifiers, and a recorder. The electrodes attach to the scalp, and their leads are connected to a recorder, usually worn on a belt. Ambulatory monitoring is not necessary to evaluate most seizures, which are usually readily diagnosed by routine EEG studies, physical examination, and history.

Ambulatory EEG monitoring is, however, a diagnostic procedure for individuals in whom a seizure diathesis is suspected but not defined by history, physical examination, or resting EEG. Ambulatory EEG monitoring may facilitate the differential diagnosis between seizures and syncopal attacks, sleep apnea, cardiac arrhythmias, or hysterical episodes. The test may also allow the professional provider to identify the epileptic nature of some episodic periods of disturbed consciousness, mild confusion, or peculiar behavior, where resting EEG is not conclusive. Additionally, it may also estimate seizure frequency, which may at times help to evaluate the effectiveness of a drug and determine its appropriate dosage.

EEG video monitoring combines the simultaneous recording of the EEG and video monitoring of behavior. This allows for correlation of ictal and interictal electrical events with demonstrated or recorded seizure symptomology. The combination of electroencephalographic and video monitoring of an individual is useful in the initial diagnosis of epilepsy, particularly where previous attempts to define or characterize the seizure activity have proven inconclusive. Beyond the initial diagnosis of epilepsy, the combination is useful in uncharacterized events, identifying affected areas of the brain, and confirmation and/or differentiation between epileptic and nonepileptic events. Additionally, the study may be used in the pediatric population where history and clinical descriptions of seizure activity are difficult to obtain.

It is anticipated that clinical examination and routine electroencephalographic studies be used before employing electroencephalographic and video monitoring, and that this study be essential to the establishment of an appropriate treatment regimen.

References

American Clinical Neurophysiology Society. Guideline twelve: guidelines for long-term monitoring for epilepsy. J Clin Neurophysiol. 2008;25(3):170-180.

Benbadis SR. EEG Video Monitoring. [Medscape Web site]. 05/11/2018. Available at: http://emedicine.medscape.com/article/1137908overview. Accessed February 10, 2023.

Cascino GD. Surgical treatment of epilepsy in adults. 11/11/2022. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 10, 2023.

Goodwin E, Kandler RH, Alix JJ. The value of home video with ambulatory EEG: a prospective service review. Seizure. 2014;23(6):480-482.

Moeller J, Haider HA, Hirsch LJ. Video and ambulatory EEG monitoring in the diagnosis of seizures and epilepsy. 02/23/2021. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 23, 2021.

Nickels KC. Routine versus extended outpatient EEG: too short, too long, or just right? Epilepsy Curr. 2016;16(6): 382-383.

Schachter SC. Evaluation and management of the first seizure in adults. 10/26/2022. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 10, 2023.

Schachter SC. Overview of the management of epilepsy in adults. 04/25/2022. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 10, 2023.

Shih T. Seizures and epilepsy in older adults: Etiology, clinical presentation, and diagnosis. 08/10/2021. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 10, 2023.

St. Louis EK, Frey LC (Eds.). Electroencephalography (EEG): An Introductory Text and Atlas of Normal and Abnormal Findings in Adults, Children and Infants. Chicago: American Epilepsy Society; 2016.

Wilfong A. Epilepsy syndromes in children. 06/28/2022. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 10, 2023.

Wilfong A. Seizures and epilepsy in children: Refractory seizures. 06/01/2022. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 10, 2023.

Coding

CPT Procedure Code Number(s)

MEDICALLY NECESSARY

95700, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

N/A

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Revisions From 07.03.25a:

03/22/2023	The policy has been reviewed and reissued to communicate the Company’s continuing position on Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home.
08/24/2022	The policy has been reviewed and reissued to communicate the Company’s continuing position on Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home.
09/22/2021	This policy has been reissued in accordance with the Company's annual review process.
02/26/2020	This policy has been reissued in accordance with the Company's annual review process.
01/01/2020	This version of the policy will become effective on 01/01/2020 due to coding updates. The following codes are being deleted from the policy: 95950 95951 95953 The following codes are being added to this policy: 95700 95705 95706 95707 95708 95709 95710 95711 95712 95713 95714 95715 95716 95717 95718 95719 95720 95721 95722 95723 95724 95725 95726

Revisions From 07.03.25:

10/09/2019	This policy has been reissued in accordance with the Company's annual review process.
04/30/2018	This new policy was been issued to communicate the Company's coverage position for Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home.

Version Effective Date:

1/1/2020

Version Issued Date:

1/2/2020

Version Reissued Date:

3/22/2023