CurrentOklahoma Health Care AuthorityPolicy N/A

Long-term Electroencephalographic (EEG) Monitoring

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This guideline governs medical necessity and prior authorization for long-term continuous EEG and video-EEG monitoring, including technical and professional components. It applies to providers requesting or documenting these services for OHCA members.

Policy Summary

PayerOklahoma Health Care Authority

PolicyLong-term Electroencephalographic (EEG) Monitoring

Policy CodePolicy N/A

Change TypeRevision of Existing Criteria

Effective DateFebruary 3, 2021

Next Review DateFebruary 2024

Key ActionObtain prior authorization and submit medical-necessity documentation for listed EEG setup and long-term EEG/VEEG services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≥2 hoursMinimum long-term EEG duration

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CurrentOklahoma Health Care AuthorityPolicy N/A

Long-term Electroencephalographic (EEG) Monitoring

Customize your policy alerts

Sign up for all Oklahoma Health Care Authority policy alerts

Know when Oklahoma Health Care Authority releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerOklahoma Health Care Authority

PolicyLong-term Electroencephalographic (EEG) Monitoring

Policy CodePolicy N/A

Change TypeRevision of Existing Criteria

Effective DateFebruary 3, 2021

Next Review DateFebruary 2024

Key ActionObtain prior authorization and submit medical-necessity documentation for listed EEG setup and long-term EEG/VEEG services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≥2 hoursMinimum long-term EEG duration

Additional review threshold

12 monthsExpected repeat frequency

12Intermittent monitoring patient limit

4Continuous monitoring patient limit

27Covered EEG procedure codes

Coverage Criteria

General medical necessity and documentation

Medical necessity and documentation requirements must all be met.

General requirements

Required submission elements
- Medical necessity must be met, supported by adequate objective medical records and evidence sufficient to justify the member’s need for the service.
- Submit an order from a contracted qualified health professional involved in the patient’s treatment, requesting extended monitoring EEG or VEEG and specifying the number of units requested and the location where the service will be administered.
- Submit clinical documentation including the diagnosis, history and physical examination, previous EEG results, and neuroimaging, if available.
- Submit the current treatment plan; current medications; medications previously tried, failed, or contraindicated, including medication names and dates tried; and documentation of seizure activity, including frequency, intensity, and any hospitalizations.

Covered indications

Coverage is supported when ANY of the following indications applies.

Diagnostic and classification indications
- Episodic events in which epilepsy is suspected but the history, examination, and routine EEG are inconclusive or nondiagnostic.
- Differentiation between neurological, cardiac, or psychogenic origin of seizures when conventional tests are inconclusive or nondiagnostic.
- Suspected non-epileptic events in a patient with confirmed epilepsy.
- Classification of seizure type in a patient with confirmed epilepsy.
- Localization of seizure focus in a patient with confirmed epilepsy.

Repeat monitoring

Repeat monitoring is subject to additional physician review when requested more frequently than once in 12 months.

Additional repeat-study justification: The request must include physician review and documentation clearly describing why additional testing is necessary for diagnostic purposes or potential treatment adjustments.More frequently than once per 12 months

Once a diagnosis has been established, this study is not expected to be repeated or used for monitoring a therapeutic regimen.

Monitoring beyond 72 hours

Monitoring beyond 72 hours requires additional review.

Extended-duration monitoring: The request must include physician review and written documentation supporting each additional 24 hours of monitoring.>72 hours; each additional period is 24 hours

Studies of neonates or unattended, non-cooperative patients are identified as contraindicated and do not meet coverage criteria.

Localization of a seizure focus or foci is contraindicated when seizure symptoms or other EEG findings indicate bilateral foci or rapid generalization.

Coding and Monitoring Parameters

EEG SetupCPTCovered

95700

EEG Setup

EEG Monitoring - Technical ComponentCPTCovered

95705	EEG, no video, monitoring technical component, 2-12 hours, unmonitored
95706	EEG, no video, monitoring technical component, 2-12 hours, intermittent
95707	EEG, no video, monitoring technical component, 2-12 hours, continuous
95708	EEG, no video, monitoring technical component, 12-26 hours, unmonitored
95709	EEG, no video, monitoring technical component, 12-26 hours, intermittent
95710	EEG, no video, monitoring technical component, 12-26 hours, continuous
95711	Video-EEG, monitoring technical component, 2-12 hours, unmonitored
95712	Video-EEG, monitoring technical component, 2-12 hours, intermittent
95713	Video-EEG, monitoring technical component, 2-12 hours, continuous
95714	Video-EEG, monitoring technical component, 12-26 hours, unmonitored

1–10 of 12

1/2

EEG Monitoring - Professional ComponentCPTCovered

95717	Professional component, EEG no video, 2-12 hours, partial day
95718	Professional component, video EEG, 2-12 hours, partial day
95719	Professional component, EEG no video, 12-26 hours, full day
95720	Professional component, video EEG, 12-26 hours, full day
95721	Professional component, EEG no video, 36-60 hours, 2 days
95722	Professional component, video EEG, 36-60 hours, 2 days
95723	Professional component, EEG no video, 60-84 hours, 3 days
95724	Professional component, video EEG, 60-84 hours, 3 days
95725	Professional component, EEG no video, 84 hours or more, 4+ days
95726	Professional component, video EEG, 84 hours or more, 4+ days

Long-term recording duration

Minimum durationAt least 2 hours

Recording distinctionTesting typically defined as less than 2 hours is distinguished from long-term continuous recording EEG

Recording purposeLong-term recording captures brain-wave activity for clinical evaluation of seizures and other abnormalities

Intermittent monitoring review interval

Review intervalAt least every 2 hours during the entire recording

Required documentationThe EEG technologist must perform and document real-time review of the data

Authorization and Documentation Requirements

Prior Authorization

Obtain prior authorization before billing

The listed EEG setup and long-term EEG/VEEG technical and professional component CPT codes require prior authorization. The request must demonstrate medical necessity and include the required order and clinical documentation.

Documentation Required

Include a qualified provider order

Submit an order from a contracted qualified health professional involved in the patient’s treatment. The order must include the number of units requested and the location where the extended monitoring EEG/VEEG will be administered.

Documentation Required

Provide clinical records and prior testing

Background

Long-term EEG monitoring records brain-wave activity for at least 2 hours and may include synchronous video of the patient's clinical behavior. It is used to distinguish epileptic seizures from syncope, cardiac or sleep-related events, and psychogenic events; classify or localize seizures; evaluate seizure frequency and treatment response; and support epilepsy surgery evaluation. Technical services may be unmonitored, intermittently monitored, or continuously monitored, while professional services include qualified review, interpretation, and reporting.

Definitions

Electroencephalogram (EEG)

PurposeA diagnostic test used to measure the electrical activity of the brain

EquipmentHighly sensitive recording equipment is attached to the scalp by fine electrodes

Typical durationTesting is typically less than 2 hours

EEG technologist

QualificationQualified through education, training, and licensure, certification, or regulation when applicable in seizure recognition

Core responsibilitiesPerforms EEG setup, takedown when performed, patient education, technical descriptions, and equipment maintenance

Clinical responsibility

Policy Summary

PayerOklahoma Health Care Authority

PolicyLong-term Electroencephalographic (EEG) Monitoring

Policy CodePolicy N/A

Change TypeRevision of Existing Criteria

Effective DateFebruary 3, 2021

Next Review DateFebruary 2024

Key ActionObtain prior authorization and submit medical-necessity documentation for listed EEG setup and long-term EEG/VEEG services.

SourceLink

On This Page

Identification of absence seizures, including blanking out or staring, for medication management.

Suspected seizures associated with sleep disturbances when routine EEG is inconclusive or nondiagnostic.

Seizures precipitated by naturally occurring cyclic events or environmental stimuli that are not reproducible in a hospital or clinic setting, when routine EEG is inconclusive or nondiagnostic.

Surgical evaluation

Pre-operative evaluation of a patient undergoing epilepsy surgery.

Review purposeReview supports recording integrity and quality, identifies maintenance needs, and allows clinical issues to be reported to the physician or other qualified health care professional

Intermittent concurrent patient limit

Concurrent patient limitMaximum 12 patients

Monitoring modeIntermittent monitoring may be provided remotely or on-site

Exceeding the limitIf the number of patients exceeds 12, the study is considered unmonitored

Continuous concurrent patient limit

Concurrent patient limitMaximum 4 patients

Monitoring requirementThe EEG technologist must perform and document concurrent real-time monitoring of EEG data and video when video is performed

Exceeding the limitIf the patient number exceeds 4, the study is considered intermittent monitoring

Extended monitoring review threshold

Review thresholdMonitoring beyond 72 hours

Documentation intervalWritten documentation is required for each additional 24 hours of monitoring

Review requirementPhysician review is required

Repeat monitoring frequency

Frequency thresholdMore frequently than once in a 12-month period

Review requirementPhysician review is required

Additional justificationDocumentation must clearly explain why additional testing is necessary for diagnostic purposes or potential treatment adjustments

Submit clinical documentation including the diagnosis, history and physical examination, previous EEG results, and neuroimaging when available.

Documentation Required

Document treatment and seizure history

Document the current treatment plan, current medications, and medications previously tried, failed, or contraindicated. Include medication names and dates tried, along with seizure activity details, including frequency, intensity, and any hospitalizations.

Documentation Required

Submit additional physician review

For monitoring beyond 72 hours or testing more frequently than once in a 12-month period, provide physician-review documentation explaining the need for the additional monitoring or repeat diagnostic study.

Denial Risk

Demonstrate medical necessity

The request may be denied when medical necessity is not demonstrated through adequate objective medical records sufficient to justify the member’s need for the service.

Denial Risk

Complete all supporting documentation

Requests may be denied or pended when required supporting information is missing, including the order, requested units, service location, clinical history, prior testing, treatment information, or seizure documentation.

Denial Risk

Support each additional 24 hours

Monitoring beyond 72 hours requires physician review and written documentation supporting each additional 24-hour period of monitoring.

Denial Risk

Justify repeat monitoring

Long-term EEG monitoring requested more frequently than once in a 12-month period requires physician review and clear documentation explaining why additional testing is necessary for diagnostic purposes or potential treatment adjustments.

Denial Risk

Avoid contraindicated indications

The guideline identifies studies of neonates or unattended, non-cooperative patients as contraindicated. Seizure-focus localization is also contraindicated when seizure symptoms or EEG findings indicate bilateral foci or rapid generalization.

Performs seizure recognition within the applicable scope of practice and as allowed by law, regulation, and facility policy

Long-term continuous recording EEG

Minimum durationEEG recording for a duration equal to or greater than 2 hours

Diagnostic purposesUsed to differentiate seizures from other abnormalities and determine seizure type or location

Additional usesMay monitor treatment or status epilepticus, evaluate epilepsy surgery candidacy, or screen for adverse change in critically ill patients

Status epilepticus

DefinitionA dangerous condition in which epileptic seizures follow one another without recovery of consciousness between them

Medical significanceIt is a life-threatening medical emergency

RiskTreatment delay can result in a life-threatening emergency

Video EEG monitoring (VEEG)

Recording methodSynchronous recording and display of EEG patterns and videorecorded clinical behavior

DurationTypically conducted over several days

Clinical usesCorrelates electrophysiological changes with behavior, distinguishes epileptic from non-epileptic events, and identifies the brain area from which seizures arise

Intermittent monitoring

Review intervalAn EEG technologist performs and documents real-time review at least every 2 hours throughout the recording

Review purposeReview assures recording integrity and quality, identifies maintenance needs, and supports notification of clinical issues

Concurrent patient limitThe technologist may monitor no more than 12 patients concurrently

Continuous real-time monitoring

Core requirementIncludes all intermittent-monitoring requirements

Real-time monitoringThe technologist performs and documents concurrent real-time monitoring of EEG data and video when performed throughout the recording

Patient limit and downgradeA technologist may monitor no more than 4 patients concurrently; a break in real-time monitoring or more than 4 patients makes the study intermittent monitoring