CAM 20114

Electroencephalograms (EEG)

Category:Medicine   Last Reviewed:March 2019
Department(s):Medical Affairs   Next Review:March 2999
Original Date:March 1996    

Description:
An electroencephalogram (EEG) is a recording of the electrical current potentials spontaneously from nerve cells in the brain onto the skull. Variations in wave characteristics correlate with neurological conditions and are used to diagnose conditions.

EEGs can be transmitted by telephone in which electrical brain activity is recorded and transmitted to an off-site center for interpretation and report or by radio or cable in the diagnosis of complex seizure variants that require inpatient monitoring, but do not require the patient to be in bed.

EEGs can be recorded by 24-hour ambulatory cassette. Twenty-four hour ambulatory cassette-recorded EEGs offer the ability to record the EEG on a long-term, outpatient basis. Electrodes for at least four recording channels are secured on the patient. The cassette recorder is attached to the patient’s waist or on a shoulder harness. Recorded electrical activity is analyzed by playback through an audio amplifier system and video monitor.

Electroencephalographic video monitoring is the simultaneous recording of the EEG and video monitoring of patient behavior. This allows for the correlation of ictal and interictal electrical events with demonstrated or recorded seizure symptomology. This type of monitoring allows the patient’s face or entire body to be displayed on a video screen.

Policy:
Transmission of the EEG by telephone, radio or cable is considered MEDICALLY NECESSARY when the closest medical facilities are located in remote areas which lack trained EEG interpreters for patients with the following indications:

  • Altered consciousness, such as stuporous, semicomatose or comatose states
  • Atypical seizure variants in patients experiencing bizarre, distressing symptoms as seen with "spike and wave stupor" or other forms of seizure disorders
  • Head injury, where a subdural hematoma may be identified or
  • Differentiation of complicated migraine with epilepsy-like symptoms (e.g., auras, alterations in level of consciousness) from true seizure disorders

Telephone transmission of the EEG to determine electrocerebral silence, i.e., brain death, is considered INVESTIGATIONAL.

Radio and cable telemetry of the EEG is considered MEDICALLY NECESSARY with prior approval for an:

  • EEG recording during provocation testing (e.g., withdrawal of anticonvulsant medications), which can be safely undertaken only in the immediate proximity of emergency medical personnel and technology.
  • And an EEG recording attempting to localize the seizure focus prior to surgery when ambulation is desirable (e.g., when seizures are triggered by specific environmental stimuli or daily events).

Twenty-four hour ambulatory cassette-recorded EEGs are MEDICALLY NECESSARY with prior approval in the following circumstances:

  • When used in conjunction with ambulatory electrocardiogram (ECG) recordings for seizures suspected to be of cardiogenic origin
  • When used in conjunction with electro-oculogram (EOG) and electromyogram (EMG) recordings for suspected seizures of sleep disturbances
  • When used for quantification of seizures in patients who experience frequent absence seizures and
  • When used in documenting seizures which are precipitated by naturally occurring cyclic events or environmental stimuli which are not reproducible in the hospital or clinic setting

Twenty-four hour ambulatory cassette-recorded EEGs are considered INVESTIGATIONAL in the following circumstances:

  • For the study of neonates or unattended, noncooperative patients
  • In localization of seizure focus/foci when the seizure symptoms and/or other EEG recordings indicate the presence of bilateral foci or rapid generalization and
  • For final evaluation of patients who are being considered as candidates for resective surgery.  
  • EEG video monitoring is MEDICALLY NECESSARY for the following indications, where the diagnosis cannot be made by neurological examination, standard EEG studies and ambulatory cassette EEG monitoring and non-neurological causes of symptoms (e.g., syncope, cardiac arrhythmias) have been ruled out: 
      • To differentiate epileptic events from psychogenic seizures
      • To establish the specific type of epilepsy in poorly characterized seizure types where such characterization is medically necessary to select the most appropriate therapeutic regimen
      • Upon individual case review, to establish the diagnosis of epilepsy in very young children
      • For identification and localization of a seizure focus in persons with intractable epilepsy who are being considered for surgery
      • Recurrent seizures when medicated with 2 or more anticonvulsants with therapeutic levels and no concurrent seizure-provoking medications.
  • Once a diagnosis is determined, continued video EEG monitoring (e.g., for monitoring response to therapy or titrating medication dosages) is considered NOT MEDICALLY NECESSARY. Response to therapy can be assessed using standard EEG monitoring or ambulatory cassette EEG monitoring. The duration of ambulatory EEG monitoring that is considered medically necessary depends on the frequency of the person’s symptoms that are being investigated, and generally can be completed in 3 to 5 days.
  • EEG video monitoring is INVESTIGATIONAL for all other indications.

References:

  1. Sheth RD, Intractable pediatric epilepsy: Presurgical evaluation. Semin Pediatr Neurol. 2000;7(3):158-165.
  2. Bowman ES, Coons PM. The differential diagnosis of epilepsy, pseudoseizures, dissociative identity disorder, and dissociative disorder not otherwise specified. Bull Menninger Clin. 2000;64(2):164-180.
  3. Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clin Proc. 2002;77(10):1111-1120.
  4. Cascino GD. Video-EEG monitoring in adults. Epilepsia. 2002;43 Suppl 3:80-93.
  5. Cragar DE, Berry DT, Fakhoury TA, et al. A review of diagnostic techniques in the differential diagnosis of epileptic and nonepileptic seizures. Neuropsychol Rev. 2002;12(1):31-64.
  6. Ross SD, Estok, R, Chopra S, et al. Management of newly diagnosed patients with epilepsy: A systematic review of the literature. Evidence Report/Technology Assessment No.39. Prepared by MetaWorks, Inc.for the Agency for Healthcare Research and Quality (AHRQ). AHRQ Publication No. 01-E038, Rockville, MD: AHRQ; September 2001.
  7. Abubakr A, Wambacq I. Seizures in the elderly: Video/EEG monitoring analysis. Epilepsy Behav. 2005;7(3):447-450.
  8. Alsaadi TM, Marquez AV. Psychogenic nonepileptic seizures. Am Fam Physician. 2005;72(5):849-856.
  9. Boon PA, Williamson PD. The diagnosis of pseudoseizures. Clin Neurol Neurosurg. 1993;95(1):1-8.
  10. Bowman ES, Coons PM. The differential diagnosis of epilepsy, pseudoseizures, dissociative identity disorder, and dissociative disorder not otherwise specified. Bull Menninger Clin. 2000;64(2):164-180.
  11. Cascino GD. Use of routine and video electroencephalography. Neurol Clin. 2001;19(2):271-287.
  12. Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clin Proc. 2002;77(10):1111-1120.
  13. Cascino GD. Video-EEG monitoring in adults. Epilepsia. 2002;43 Suppl 3:80-93.
  14. Chapell R, Reston J, Snyder D, et al. Management of treatment-resistant epilepsy. Evidence Report/Technology Assessment No. 77. Prepared by the ECRI Evidence-based Practice Center for the Agency for Healthcare Research and Quality (AHRQ). AHRQ Publication Number 03-0028. Rockville, MD: AHRQ; May 2003. Available at: http://www.ahrq.gov/clinic/evrptfiles.htm#trepilep. Accessed May 5, 2004.
  15. Cossu M, Cardinale F, Colombo N, et al. Stereoelectroencephalography in the presurgical evaluation of children with drug-resistant focal epilepsy. J Neurosurg. 2005;103(4 Suppl):333-343.
  16. Cragar DE, Berry DT, Fakhoury TA, et al. A review of diagnostic techniques in the differential diagnosis of epileptic and nonepileptic seizures. Neuropsychol Rev. 2002;12(1):31-64.
  17. Erlichman M. Electroencephalographic (EEG) video monitoring. DHHS Publication No. (PHS) 91-3471. Rockville, MD: Agency for Healthcare Policy and Research (AHCPR); December 1990:1-14.
  18. Leis AA. Psychogenic seizures. The Neurologist. 1996;2:141-149.Meierkord H, Will B, Fish D, Shorvon S. The clinical features and prognosis of pseudoseizures diagnosed using video-EEG telemetry. Neurology. 1991;41(10):1643-1646.
  19.  Ross SD, Estok R, Chopra S, et al. Management of newly diagnosed patients with epilepsy: A systematic review of the literature. Evidence Report/Technology Assessment No. 39. Prepared by MetaWorks, Inc. for the Agency for Healthcare Research and Quality (AHRQ). AHRQ Publication No. 01-E038. Rockville, MD: AHRQ; September 2001. Available at: http://www.ahrq.gov/clinic/evrptfiles.htm#trepilep. Accessed May 5, 2004.
  20. Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of epilepsy in adults. A national clinical guideline. SIGN Publication No. 70. Edinburgh, Scotland: SIGN; April 2003.
  21. Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of epilepsies in children and young people. SIGN Publication No. 81. Edinburgh, Scotland: SIGN; March 2005.
  22. Sheth RD. Intractable pediatric epilepsy: Presurgical evaluation. Semin Pediatr Neurol. 2000;7(3):158-165.
  23. Sundaram M, Sadler RM, Young GB, et al. EEG in epilepsy: Current perspectives. Can J Neuro Sci. 1999;26:255-262.
  24. Valente KD, Freitas A, Fiore LA, et al. The diagnostic role of short duration outpatient V-EEG monitoring in children. Pediatr Neurol. 2003;28(4):285-291.
  25. Wood BL, Haque S, Weinstock A, Miller BD. Pediatric stress-related seizures: Conceptualization, evaluation, and treatment of nonepileptic seizures in children and adolescents. Curr Opin Pediatr. 2004;16(5):523-531.
  26. Wyllie E, Friedman D, Rothner AD, et al. Psychogenic seizures in children and adolescents: Outcome after diagnosis by ictal video and electroencephalographic recording. Pediatrics. 1990;85(4):480-484.
  27. Noe, Semin Neurol 2011, 31:54-64.
  28. Kwan et al., Epilepsia 2010, 51: 1069-77.
  29. Berg, Neurol Clin 2009, 27: 1003-13.
  30. Blue Cross and Blue Shield of Kansas Internal Medicine Liaison Committee, August 30, 2006 (see Blue Cross and Blue Shield of Kansas Newsletter, Blue Shield Report. MAC–03-06).
  31. Blue Cross and Blue Shield of Kansas Medical Advisory Committee (MAC) meeting, November 2, 2006 (see Blue Cross and Blue Shield of Kansas Newsletter, Blue Shield Report. MAC–03-06).

Coding Section

Codes Number Description
CPT  95700 (effective 01/01/2020)

Electroencephalogram (EEG) continuous recording, with video when performed, setup, patient education, and takedown when performed, administered in person by EEG technologist, minimum of 8 channels

  95705 (effective 01/01/2020)

Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist, 2-12 hours; unmonitored 

  95706 (effective 01/01/2020) with intermittent monitoring and maintenance 
  95707 (effective 01/01/2020)

with continuous, real-time monitoring and maintenance

  95708 (effective 01/01/2020)

Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored 

  95709 (effective 01/01/2020)

with intermittent monitoring and maintenance 

  95710 (effective 01/01/2020)

with continuous, real-time monitoring and maintenance

  95711 (effective 01/01/2020)

Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, 2-12 hours; unmonitored

  95712 (effective 01/01/2020)

with intermittent monitoring and maintenance

  95713 (effective 01/01/2020)

with continuous, real-time monitoring and maintenance

  95714 (effective 01/01/2020)

Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored

  95715 (effective 01/01/2020) with intermittent monitoring and maintenance 
  95716 (effective 01/01/2020)

with continuous, real-time monitoring and maintenance 

  95717 (effective 01/01/2020)

Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report, 2-12 hours of EEG recording; without video 

  95718 (effective 01/01/2020) with video (VEEG) 
  95719 (effective 01/01/2020)

Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpretation and report after each 24-hour period; without video 

  95720 (effective 01/01/2020) with video (VEEG) 
  95721 (effective 01/01/2020)

Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 36 hours, up to 60 hours of EEG recording, without video

  95722 (effective 01/01/2020)

greater than 36 hours, up to 60 hours of EEG recording, with video (VEEG)

  95723 (effective 01/01/2020)

greater than 60 hours, up to 84 hours of EEG recording, without video 

  95724 (effective 01/01/2020)

greater than 60 hours, up to 84 hours of EEG recording, with video (VEEG) 

  95725 (effective 01/01/2020) greater than 84 hours of EEG recording, without video 
  95726 (effective 01/01/2020)

greater than 84 hours of EEG recording, with video (VEEG)

  95819 Electroencephalogram (EEG), including recording awake and asleep, with hyperventilation and/or photic stimulation
  95950 Monitoring for identification and lateralization of cerebral seizure focus by attached electrodes; electroencephalographic (e.g., 8 channel EEG) and video recording and interpretation, each 24 hours
  95951 Combined electroencephalographic (EEG) and video recording and interpretation, each 24 hours
  95956 Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours
ICD-9 Procedure 89.19 Video and radio-telemeter electroencephalographic monitoring
ICD-9 Diagnosis 345.00-345.01 Generalized non-convulsive epilepsy code range
  345.00-345.91 Epilepsy code range
  345.50-345.51 Partial epilepsy without mention of impairment of consciousness (includes sensory/inducers epilepsy)
  346.00-346.01 Classic migrain code range
  347 Cataplexy and narcolepsy
  780.01-780.9 Alteration of consciousness code range
  780.3 Convulsions
HCPCS A4556 Electrodes
ICD-10-CM (effective 10/01/15)  G40309  Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus 
  G40311  Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus 
  G40301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus
  G40201  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus 
  G40209  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus 
  G40211  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus 
  G40219  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus 
  G40101  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus 
  G40109  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus 
  G40111  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus 
  G40119 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus 
  G40401  Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus 
  G40409  Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus 
  G40411  Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus 
  G40419  Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus 
  G40501  Epileptic seizures related to external causes, not intractable, with status epilepticus 
  G40509 Epileptic seizures related to external causes, not intractable, without status epilepticus 
  G40802  Other epilepsy, not intractable, without status epilepticus 
  G40804  Other epilepsy, intractable, without status epilepticus 
  G40901  Epilepsy, unspecified, not intractable, with status epilepticus 
  G40909 Epilepsy, unspecified, not intractable, without status epilepticus
  G40911  Epilepsy, unspecified, intractable, with status epilepticus 
  G40919  Epilepsy, unspecified, intractable, without status epilepticus 
  G43109  Migraine with aura, not intractable, without status migrainosus 
  G43119  Migraine with aura, intractable, without status migrainosus 
  G47419  Narcolepsy without cataplexy 
  R4020  Unspecified coma
  R404  Transient alteration of awareness 
  R403  Transient alteration of awareness 
  R400  Somnolence 
  R401  Stupor
  R440  Auditory hallucinations
  R442  Other hallucinations 
  R443  Hallucinations, unspecified 
  R55  Syncope and collapse 
  R5600  Simple febrile convulsions 
  R5601  Complex febrile convulsions 
  R561  Post traumatic seizures 
  R569  Unspecified convulsions 
  R42  Dizziness and giddiness 
  G479 Sleep disorder, unspecified 
  G4730  Sleep apnea, unspecified 
  G4700  Insomnia, unspecified 
  G4710  Hypersomnia, unspecified 
  G4720 Circadian rhythm sleep disorder, unspecified type
  G478  Other sleep disorders 
  F518 Other sleep disorders not due to a substance or known physiological condition 
  G478 Other sleep disorders 
  R502  Drug induced fever 
  R509  Fever, unspecified 
  R5081  Fever presenting with conditions classified elsewhere 
  R5082  Postprocedural fever 
  R5083  Postvaccination fever 
  R6883  Chills (without fever) 
  R680  Hypothermia, not associated with low environmental temperature 
  R5084  Febrile nonhemolytic transfusion reaction 
  R5382  Chronic fatigue, unspecified 
  R532  Chronic fatigue, unspecified 
  G933  Postviral fatigue syndrome 
  R531  Weakness 
  R5381  Other malaise 
  R5383  Other fatigue 
  R61  Generalized hyperhidrosis 
 ICD-10-PCS (effective 10/01/15) 4A1034Z  Monitoring of Central Nervous Electrical Activity, Percutaneous Approach 
  4A10X4Z  Monitoring of Central Nervous Electrical Activity, External Approach 
  4A1134Z  Monitoring of Peripheral Nervous Electrical Activity, Percutaneous Approach 
  4A11X4Z  Monitoring of Peripheral Nervous Electrical Activity, External Approach 
Type of Service Medical  
Place of Service Telephone: Outpatient, HomeRadio and Cable: Outpatient, HomeCassette: Inpatient, Outpatient Video: Inpatient  

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

01/13/2020 

Added CPT codes 95700 - 95726. No other changes made. 

03/01/2019 

Annual review. No change to policy intent. 

03/19/2018 

Annual review. No change to policy intent. 

03/02/2017 

Annual review. No change to policy intent. 

03/03/2016 

Annual review. No change made to policy. 

09/21/2015 

Added ICD-10 codes. 

03/10/2015 

Annual review. No change to policy intent. Added coding.

03/18/2014

Annual review. Added more specific policy verbiage regarding Video EEG.  Added References. Policy intent is unchanged.


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