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CPT 5200F: Neurosurgical Referral Consideration for Intractable Epilepsy

CPT code 5200F indicates that a clinician has, within the previous three years, considered referring a patient to a neurosurgical specialist to evaluate candidacy for surgical treatment of intractable epilepsy. Nationally, this measure matters because timely recognition of surgical candidacy can affect long-term outcomes for patients with medically refractory seizures and supports multidisciplinary management pathways.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical intent and service context, benchmarks and utilization patterns where available, and relevant policy or coverage considerations affecting neurosurgical referral for epilepsy. The publication also outlines expected sites of service and service line implications for outpatient neurology practices and epilepsy centers.

This summary is intended for clinicians, billing professionals, and policy analysts seeking a clear national overview of CPT code 5200F, its clinical purpose, and the payment and care coordination context surrounding referral evaluation for epilepsy surgery.

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Billing Code Overview

CPT code 5200F documents that a provider has, within the past three years, considered referring a patient to a neurosurgical specialist to evaluate candidacy for surgical therapy to treat intractable epilepsy. This code captures a documented clinical consideration of neurosurgical referral as part of epilepsy care.

Service type: Specialist referral consideration / care coordination related to evaluation for epilepsy surgery
Typical site of service: Outpatient neurology clinic or other ambulatory care setting where epilepsy management and referral decisions occur

Data not available in the input.

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CPT 5200F: Neurosurgical Referral Consideration for Intractable Epilepsy

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Billing Code Overview

Service type: Specialist referral consideration / care coordination related to evaluation for epilepsy surgery
Typical site of service: Outpatient neurology clinic or other ambulatory care setting where epilepsy management and referral decisions occur

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or adolescent with medically refractory focal or generalized epilepsy who continues to experience disabling seizures despite trials of two or more appropriate antiseizure medications. During an outpatient neurology follow-up visit, the neurologist documents a focused review of seizure frequency, prior medication trials, prior diagnostic testing (EEG, video EEG, brain MRI), and functional impact. The clinician records that, within the past three years, they have considered referral to a neurosurgeon or epilepsy surgical program to evaluate candidacy for surgical therapy (for example, resective surgery, laser ablation, or neuromodulation such as vagus nerve stimulation or responsive neurostimulation). Typical workflow steps include chart review, discussion with the patient and family about risks and benefits, coordination of referral to a tertiary epilepsy center or neurosurgical specialist, and scheduling of pre-surgical evaluations (long-term EEG monitoring, neuropsychological testing, and epilepsy imaging) as indicated.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	When an E/M visit is distinct from other services rendered the same day while documenting consideration of surgical referral
`57`	Decision for surgery	When the visit results in the decision to pursue surgical evaluation or admission for a surgical procedure (rare for this preventive referral code)
`59`	Distinct procedural service	When another unrelated procedure or service is performed the same day and needs separation from the referral documentation
`GT`	Via interactive audio and video telecommunication (telehealth)	When the consideration/referral occurs during a synchronous telehealth encounter
`GQ`	Via asynchronous telecommunication (store-and-forward)	When documentation arises from store-and-forward telehealth exchanges relevant to surgical consideration
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When the evaluation and referral consideration are performed during a real-time telemedicine visit
`24`	Unrelated E/M service by the same physician during a postoperative period	If the patient is in a postoperative global period for a prior procedure unrelated to the referral and a separate E/M is provided
`52`	Reduced services	If the documented service is reduced from standard but still appropriate for capturing consideration of referral (use per payer rules)
`XE`	Separate encounter (Modifiers to indicate distinctness per NCCI)	When the referral consideration occurs during a separate patient encounter that must be distinguished from other services
`XU`	Unusual non-overlapping service	When documentation supports that the consideration/referral is separate and not typically reported together

Taxonomy Code	Specialty	Notes
2084P0800X	Neurologist	Neurologists commonly document consideration of surgical referral for refractory epilepsy
2086S0101X	Neurological Clinical Nurse Specialist	Advanced practice clinicians who manage epilepsy and coordinate referrals
208W00000X	Neurosurgeon	Neurosurgeons receive referrals for surgical candidacy evaluations
207RE0101X	Neuropsychologist	Performs pre-surgical cognitive evaluations; included as related specialty
363L00000X	Clinical Neurophysiologist	Specialists involved in EEG and long-term monitoring used in surgical workup

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G40.111`	Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus	Focal, medication-refractory epilepsy is a common indication prompting consideration of surgical referral
`G40.311`	Generalized epilepsy and epileptic syndromes, intractable, with status epilepticus	Intractable generalized epilepsy may prompt evaluation for neuromodulation or other surgical options
`G40.901`	Epilepsy, unspecified, intractable, without status epilepticus	General code for intractable epilepsy when detailed classification is not available but surgical referral is considered
`G40.109`	Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus	May appear in records when focal epilepsy is documented and the provider is considering escalation to surgical evaluation if seizures become refractory
`R56.9`	Unspecified convulsions	Used in some diagnostic workups when seizure type is undifferentiated prior to definitive epilepsy classification and referral

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Common E/M level used when documenting detailed seizure history, medication review, and consideration of neurosurgical referral
`95816`	EEG, prolonged recording; 24 hours and longer (ambulatory)	Often used in the pre-surgical evaluation to capture seizure focus prior to surgical referral
`95951`	Monitoring for seizure localization (video-EEG)	Inpatient or outpatient video-EEG monitoring is a key diagnostic step after referral to an epilepsy center
`96132`	Neuropsychological testing, administration by physician or other qualified health care professional	Used in pre-surgical cognitive assessment to evaluate risk/benefit of resection or neuromodulation
`61885`	Stereotactic placement of cranial neurostimulator electrodes; 1 lead, for responsive neurostimulation	Represents a surgical treatment option that the patient may be referred for after surgical evaluation

Related Codes

CPT-5005F-UNDEFINED-MEASURE

CPT 5005F: Undefined Reporting Measure

CPT-5010F-UNKNOWN-SERVICE

CPT 5010F: Service Description Not Available

CPT-5015F-UNSPECIFIED-SERVICE

CPT 5015F: Unspecified Service

CPT-5020F-CLINICAL-SERVICE

CPT 5020F: Clinical Service

CPT-5050F-UNKNOWN-SERVICE

CPT 5050F: Unknown Clinical Service

CPT-5060F-PERFORMANCE-MEASURE

CPT 5060F: Performance Measure Entry, No Summary Available

CPT-5062F-CLINICAL-PERFORMANCE-MEASURE

CPT 5062F: Clinical Performance Measure

CPT-5100F-NO-SUMMARY-AVAILABLE

CPT 5100F: No Summary Available

CPT-5250F-5250F-CLINICAL-CODE

CPT 5250F: Clinical Service (No Summary Provided)

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	When an E/M visit is distinct from other services rendered the same day while documenting consideration of surgical referral
`57`	Decision for surgery	When the visit results in the decision to pursue surgical evaluation or admission for a surgical procedure (rare for this preventive referral code)
`59`	Distinct procedural service	When another unrelated procedure or service is performed the same day and needs separation from the referral documentation
`GT`	Via interactive audio and video telecommunication (telehealth)	When the consideration/referral occurs during a synchronous telehealth encounter
`GQ`	Via asynchronous telecommunication (store-and-forward)	When documentation arises from store-and-forward telehealth exchanges relevant to surgical consideration
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When the evaluation and referral consideration are performed during a real-time telemedicine visit
`24`	Unrelated E/M service by the same physician during a postoperative period	If the patient is in a postoperative global period for a prior procedure unrelated to the referral and a separate E/M is provided
`52`	Reduced services	If the documented service is reduced from standard but still appropriate for capturing consideration of referral (use per payer rules)
`XE`	Separate encounter (Modifiers to indicate distinctness per NCCI)	When the referral consideration occurs during a separate patient encounter that must be distinguished from other services
`XU`	Unusual non-overlapping service	When documentation supports that the consideration/referral is separate and not typically reported together

Taxonomy Code	Specialty	Notes
2084P0800X	Neurologist	Neurologists commonly document consideration of surgical referral for refractory epilepsy
2086S0101X	Neurological Clinical Nurse Specialist	Advanced practice clinicians who manage epilepsy and coordinate referrals
208W00000X	Neurosurgeon	Neurosurgeons receive referrals for surgical candidacy evaluations
207RE0101X	Neuropsychologist	Performs pre-surgical cognitive evaluations; included as related specialty
363L00000X	Clinical Neurophysiologist	Specialists involved in EEG and long-term monitoring used in surgical workup

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G40.111`	Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus	Focal, medication-refractory epilepsy is a common indication prompting consideration of surgical referral
`G40.311`	Generalized epilepsy and epileptic syndromes, intractable, with status epilepticus	Intractable generalized epilepsy may prompt evaluation for neuromodulation or other surgical options
`G40.901`	Epilepsy, unspecified, intractable, without status epilepticus	General code for intractable epilepsy when detailed classification is not available but surgical referral is considered
`G40.109`	Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus	May appear in records when focal epilepsy is documented and the provider is considering escalation to surgical evaluation if seizures become refractory
`R56.9`	Unspecified convulsions	Used in some diagnostic workups when seizure type is undifferentiated prior to definitive epilepsy classification and referral

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Common E/M level used when documenting detailed seizure history, medication review, and consideration of neurosurgical referral
`95816`	EEG, prolonged recording; 24 hours and longer (ambulatory)	Often used in the pre-surgical evaluation to capture seizure focus prior to surgical referral
`95951`	Monitoring for seizure localization (video-EEG)	Inpatient or outpatient video-EEG monitoring is a key diagnostic step after referral to an epilepsy center
`96132`	Neuropsychological testing, administration by physician or other qualified health care professional	Used in pre-surgical cognitive assessment to evaluate risk/benefit of resection or neuromodulation
`61885`	Stereotactic placement of cranial neurostimulator electrodes; 1 lead, for responsive neurostimulation	Represents a surgical treatment option that the patient may be referred for after surgical evaluation

Related Codes

CPT-5005F-UNDEFINED-MEASURE

CPT 5005F: Undefined Reporting Measure

CPT-5010F-UNKNOWN-SERVICE

CPT 5010F: Service Description Not Available

CPT-5015F-UNSPECIFIED-SERVICE

CPT 5015F: Unspecified Service

CPT-5020F-CLINICAL-SERVICE

CPT 5020F: Clinical Service

CPT-5050F-UNKNOWN-SERVICE

CPT 5050F: Unknown Clinical Service

CPT-5060F-PERFORMANCE-MEASURE

CPT 5060F: Performance Measure Entry, No Summary Available

CPT-5062F-CLINICAL-PERFORMANCE-MEASURE

CPT 5062F: Clinical Performance Measure

CPT-5100F-NO-SUMMARY-AVAILABLE

CPT 5100F: No Summary Available

CPT-5250F-5250F-CLINICAL-CODE

CPT 5250F: Clinical Service (No Summary Provided)

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 5200F: Neurosurgical Referral Consideration for Intractable Epilepsy

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Billing Code Overview

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CPT 5200F: Neurosurgical Referral Consideration for Intractable Epilepsy

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 5200F: Neurosurgical Referral Consideration for Intractable Epilepsy

Sign up for cpt 5200F policy alerts

Billing Code Overview

CPT 5200F: Neurosurgical Referral Consideration for Intractable Epilepsy

Sign up for cpt 5200F policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 5200F represent and when is it used?

What patient scenarios and workflow steps justify documenting consideration of neurosurgical referral?

Which modifiers are relevant when reporting CPT 5200F?

What other CPT codes are commonly associated with the pre-surgical evaluation or treatment pathway?

Which diagnoses are relevant when documenting CPT 5200F and does the code indicate surgery occurred?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 5200F represent and when is it used?

What patient scenarios and workflow steps justify documenting consideration of neurosurgical referral?

Which modifiers are relevant when reporting CPT 5200F?

What other CPT codes are commonly associated with the pre-surgical evaluation or treatment pathway?

Which diagnoses are relevant when documenting CPT 5200F and does the code indicate surgery occurred?

References