Currentpriority healthPolicy NO. 91627-R1

MAGNETOENCEPHALOGRAPHY (MEG)

Policy governing clinical indications, coverage parameters, coding, and guideline support for use of magnetoencephalography (MEG) in diagnostic evaluation and presurgical planning for select neurological conditions; applies to Priority Health members and providers.

Policy Summary

Payerpriority health

PolicyMAGNETOENCEPHALOGRAPHY (MEG)

Policy CodePolicy NO. 91627-R1

Change TypeRoutine review - no material changes

Effective Date03/2026

Next Review Date

Key ActionObtain prior authorization when required and submit documentation demonstrating medical necessity per policy criteria.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3MEG CPT codes listed

2Medically necessary indications

6Past review years shown

Coverage Criteria

Medically Necessary Indications

Covered when ALL of the following are met for each indication:

Policy Summary

Payerpriority health

PolicyMAGNETOENCEPHALOGRAPHY (MEG)

Policy CodePolicy NO. 91627-R1

Change TypeRoutine review - no material changes

Effective Date03/2026

Next Review Date

Key ActionObtain prior authorization when required and submit documentation demonstrating medical necessity per policy criteria.

SourceLink

On This Page

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Coding

CPT/HCPCS CodesCPTCovered

95965	Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (e.g., epileptic cerebral cortex localization)
95966	Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, single modality (e.g., sensory, motor, language, or visual cortex localization)
95967	Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, each additional modality (e.g., sensory, motor, language, or visual cortex localization) (List separately in addition to code for primary procedure)

Revenue CodesRevenue

860	Magnetoencephalography (MEG) - General
861	Magnetoencephalography (MEG) - MEG

Provider Actions & Billing Requirements

Prior Authorization

Prior authorization may be required for MEG codes

Prior authorization may be required for MEG CPT codes (95965, 95966, 95967); when prior authorization is required, the provider must submit a request demonstrating that the service meets the policy's medical necessity criteria.

Codes listed in brief: 95965, 95966, 95967

Step Therapy

Step therapy not applicable

Step therapy does not apply to MEG; coverage is determined by meeting the clinical indications in the policy rather than by any step-therapy sequence.

Documentation Required

Submit prior authorization with medical necessity documentation

When prior authorization is required, providers must submit a request demonstrating that the MEG procedure is medically necessary per the policy criteria.

Refer to Priority Health Provider Manual for prior authorization process details.

Denial Risk

Denial risk for non-listed indications

MEG is considered experimental and/or investigational for all indications not explicitly listed as medically necessary and will be denied for those non-listed indications.

Not supported as initial imaging for new-onset seizure disorder or for known seizure disorder unless presurgical criteria are met.

Background

Magnetoencephalography (MEG) is a noninvasive neurophysiologic test that records neuromagnetic activity produced by electrical currents in the brain using superconducting quantum interference device (SQUID) sensors and computerized acquisition, and overlays functional data on anatomical images to localize brain activity for purposes such as mapping sensory, motor, language, memory functions and localizing epileptic foci for presurgical planning.

Definitions

Magnetoencephalography (MEG) — definition

DefinitionMagnetoencephalography (MEG) is a non‑invasive medical test that uses a superconducting quantum interference device (SQUID) and computerized acquisition to detect, record, and analyze neuromagnetic activity produced by electrical currents in the brain.

How it worksMEG records magnetic fields produced by neuronal electrical currents via a helmet lined with magnetic sensors; signals are displayed and analyzed to localize brain activity and are often superimposed on anatomical brain images.

Clinical uses (summary)Maps functional cortex (sensory, motor, language, memory) and localizes epileptic seizure sources to inform diagnostic evaluation and neurosurgical planning.

Device classificationMEG systems are Class II devices cleared via 510(k) (Product Codes OLY for magnetoencephalography and OLX for source localization software).

Test characteristicsMEG provides a direct, advanced measure of active brain function with high spatial resolution and the ability to separate nearby sources.

Presurgical localization — definition

DefinitionPresurgical evaluation using MEG: recording and localization of interictal epileptic discharges and ictal events to refine the epileptogenic zone for surgical planning.

PurposeTo confirm suitability for epilepsy surgery and to localize seizure onset zones when MRI or EEG are insufficient, aiding selection of surgical candidates and planning resection.

Clinical importanceMEG’s spatial resolution and source-separation capability improve refinement of the epileptogenic zone, especially in MRI‑negative focal epilepsy and focal cortical dysplasia.

Relation to other dataMEG localization is used in conjunction with other diagnostic data (e.g., MRI, EEG) to inform neurosurgical planning and avoid eloquent cortex during resection.