CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Topographic Brain Mapping (TBM) / Brain Electrical Activity Mapping (BEAM) Coverage Policy

Policy governing coverage and medical necessity determinations for topographic brain mapping (TBM)/brain electrical activity mapping for members of Blue Cross Blue Shield - Rhode Island across Medicare Advantage and commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTopographic Brain Mapping (TBM) / Brain Electrical Activity Mapping (BEAM) Coverage Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 20, 2010

Next Review DateN/A

Key ActionDo not submit claims for topographic brain mapping (HCPCS S8040) for Medicare Advantage or Commercial products because it is not covered / considered not medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

S8040HCPCS not covered

Not coveredMedicare Advantage

Not medically necessaryCommercial

No prior authAdmin requirements

10/08/2021Last updated

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Coverage and Medical Necessity

Not Medically Necessary / Not Covered

Topographic brain mapping (TBM), also called brain electrical activity mapping (BEAM), is not covered or is considered not medically necessary because evidence is insufficient to demonstrate improvement in net health outcome.

Not covered / Not medically necessary: For Medicare Advantage Plans: Topographic brain mapping is not covered.evidence insufficient to determine improvement in net health outcome

No scientific literature supports use of TBM; policy states lack of supportive scientific literature.

Not covered / Not medically necessary: For Commercial Products: Topographic brain mapping is considered not medically necessary.evidence insufficient to determine improvement in net health outcome

No scientific literature supports use of TBM; policy states lack of supportive scientific literature.

Benefits and coverage for diagnostic and analytic services may vary by member contract. Providers should verify the member’s specific benefits and limitations by reviewing the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement before ordering or billing for topographic brain mapping (TBM).

For Commercial Products, topographic brain mapping is considered not medically necessary. The policy concludes that the evidence is insufficient to demonstrate that TBM improves net health outcomes, and therefore TBM is not supported as a covered, medically necessary service for commercial members.

Billing and Coding

Not Covered / Not Medically Necessary HCPCSHCPCSNot Covered

S8040

Topographic brain mapping

Provider Requirements and Billing Actions

Prior Authorization

Not applicable

Note

Benefit Verification

Verify benefits and eligibility prior to rendering services. Benefits may vary between groups/contracts; refer to the member's Benefit Booklet, Evidence of Coverage, Subscriber Agreement, or employer agreement for applicable coverage determinations. For member-specific benefits or questions, contact the provider call center.

Denial Risk

Background

Topographic brain mapping (TBM), also called brain electrical activity mapping (BEAM), is a computerized analysis and color topographic display of electroencephalogram (EEG) rhythms and evoked potential data. TBM generates a variety of maps representing different measurement patterns with the intent of identifying patterns that distinguish pathological from normal groups. The policy notes that there is no scientific literature sufficient to support clinical use of TBM and therefore considers the procedure not medically necessary.

Definitions

Topographic brain mapping (TBM) — definitions and alternate names

TermTopographic brain mapping (TBM)

Alternate nameBrain electrical activity mapping (BEAM)

DefinitionComputerized analysis and topographic display of electroencephalogram (EEG) rhythms and evoked potential data on a color video screen.

PurposeTo create maps representing different measurement patterns intended to identify patterns that distinguish pathological groups from normal ones.

Policy summaryNo scientific literature supports use of TBM; therefore TBM/BEAM is considered not medically necessary.

Policy Revision History

2010-04-20Effective date

Policy effective date for Topographic Brain Mapping set to 2010-04-20.

2021-10-08Policy last updatedLatest

Policy last updated on 2021-10-08 (most recent review).