Aetna considers ambulatory electroencephalography (EEG) medically necessary for any of the following conditions:
Classification of seizure type in members who have epilepsy (routine EEG is equivocal) -- only ictal recordings can reliably be used to classify seizure type (or types) which is important in selecting appropriate anti-epileptic drug therapy; or
Diagnosis of a seizure disorder (epilepsy) -- members who have episodes suggestive of epilepsy when history, examination, and routine EEG do not resolve the diagnostic uncertainties (routine EEG should be negative with provocative measures); or
Localization of the epileptogenic region of the brain during pre-surgical evaluation -- to identify appropriate surgical candidates.
Aetna considers ambulatory EEG experimental and investigational for all other indications because of insufficient evidence in the peer-reviewed literature.
Duration of Monitoring:
The goal of ambulatory EEG is usually achieved within 48 hours. Ambulatory EEG monitoring for longer than 7 days may be reviewed for medical necessity.
A 24-hour ambulatory electroencephalogram (EEG) is used to record EEG tracings on a cassette or digital recorder on a continuous outpatient basis. Electrodes for at least 3 recording channels are secured to the patient's head while a digital or cassette recorder is secured to the patient's waist or to a shoulder harness. The EEG information is stored for later play back and analysis.
The advantage of 24-hour ambulatory EEG is its ability to continuously record over a prolonged period both general and localized seizure activity during near-normal activity. Recent advances in computer technology have improved available capabilities of ambulatory EEG monitors. Lighter weight, smaller, and faster processors with larger digital storage capacity have overcome earlier limitations on EEG recording and analysis. Commercially available ambulatory EEG has evolved during the last 2 decades from 3-channel analog devices to digital machines with reformable montages of up to 32 channels and computer-assisted spike and seizure detection programs.
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 investigator to identify the epileptic nature of some episodic periods of disturbed consciousness, mild confusion, or peculiar behavior, where resting EEG is not conclusive. It may be useful in documenting seizures that are precipitated by naturally occurring cyclic events or environmental stimuli, which are not reproducible in the hospital or clinic setting. It may also allow an estimate of seizure frequency, which may at times help to evaluate the effectiveness of a drug and determine its appropriate dosage.
Ambulatory monitoring, however, is not necessary to evaluate most seizures, which are usually readily diagnosed by routine EEG studies and history.
|CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT codes covered if selection criteria are met:|
|95950||Monitoring for identification and lateralization of cerebral seizure focus; electroencephalographic (e.g., 8 channel EEG) recording and interpretation, each 24 hours|
|95951||Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (e.g., for presurgical localization), each 24 hours|
|95953||Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended|
|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, attended by a technologist or nurse|
|ICD-10 codes covered if selection criteria are met:|
|G40.001 - G40.919||Epilepsy and recurrent seizures|
|P90||Convulsions of newborn|
|R25.0 - R25.9||Abnormal involuntary movements|
|R56.01||Complex febrile convulsions|
|R56.1||Post traumatic seizures|