The American Medical Association (AMA) and the Centers for Medicaid Services (CMS) are responsible for assessing disseminating the CPT® Codes to health insurance companies. These codes allow the insurance companies to identify what type of care and procedures were provided for processing purposes.
Per the CMA and AMA, complex, new Long-Term EEG monitoring CPT® Codes will go into effect on January 1, 2020, altering the billing landscape. The code revision comes as an effort to separate the technical procedures involved in long-term EEG studies from the reporting process of reading, reviewing, reporting results.
In addition, the Place of Service requirement is now being removed. This is a direct result of the technological advancements that have made it not only possible, but more common for procedures like EEGs to be conducted off-site rather than in a typical Epilepsy Monitoring Unit (EMU).
The most notable changes are as follows:
- Previously used codes 95950, 95951, 95953, 95956 will be eliminated altogether.
- Long-Term Video EEG studies’ codes have been separated into TWO NEW major groups consisting of 13 Technical Codes and 10 Professional Codes.
Additionally, there are new Intermittent Monitoring Requirements that obligate an EEG Technologist to perform and document real-time review of data at least every 2 hours during the entire recording period to assure the integrity and quality of the recording. Each EEG Technologist is limited to monitoring a maximum of 12 patients.
The following important definitions are relevant to the coding updates.
Technical Services Codes
95700 – 95716
An individual who is qualified by education, training licensure/certification/regulation (when applicable) in seizure recognition. An EEG technologist performs EEG setup, take-down (when performed), patient education, technical description, maintenance, and seizure recognition when within his or her scope of practice, and as allowed by law, regulation, and facility policy (when applicable).
Describes any long-term continuous EEG/VEEG recording, set-up, takedown when performed, and patient and caregiver education by an EEG technologist(s). To report 95700, the setup must include a minimum of 8 channels of EEG. Services with fewer than 8 channels may be reported using 95999.
The EEG Technologists’ written documentation of the reviewed EEG/VEEG data, including technical interventions.
Must include the following:
- Uploading and/or transferring data from EEG equipment to a server or storage device.
- Reviewing raw EEG/VEEG data and events and automated detection, as well as patient activations.
- Annotating, editing, and archiving EEG/VEEG data for review by the physician.
Intermittent Monitoring (Remote or On-Site)
Requires EEG technologist(s) to perform and document real-time review of the data at least every 2 hours during the entire recording period.
A single EEG technologist may monitor a maximum of 12 patients concurrently. If the number of patients exceeds 12, all studies are reported as unmonitored.
*These definitions are abbreviated and meant for discussion purposes only, not to serve as coding guidance. For complete information and coding definitions, refer to CPT®2020 Professional Edition