Currentpriority healthPolicy N/A

Magnetoencephalography (MEG) reimbursement and coding

This document defines Priority Health's reimbursement, coding, documentation, and place-of-service guidance for Magnetoencephalography (MEG) services and who it affects (providers submitting MEG claims).

Policy Summary

Payerpriority health

PolicyMagnetoencephalography (MEG) reimbursement and coding

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 18, 2025

Next Review DateN/A

Key ActionFor Medicare indications not meeting NCD/LCD/policy, complete a Pre-Service Organization Determination (PSOD); authorizations do not guarantee payment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3CPT codes listed for MEG

2Revenue codes provided

1Place of service specified

ExtensiveDocumentation requirements emphasized

MEG Coverage and Billing Rules

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.

ALL of the following

Bill MEG services using the designated CPT procedure codes: 95965, 95966, 95967 (MEG recording and analysis for spontaneous or evoked magnetic activity).
Use the primary CPT codes for MEG as listed in the policy.
Place of service: outpatient setting as specified by applicable place-of-service guidance.
Follow facility/provider place-of-service conventions when billing.

ALL of the following

Documentation and reporting must support the service and medical necessity, including: extensive workup, orders, review of prior studies, identification of true spikes, localization of events, interpretation of source and post-processed data, comparison to prior studies as applicable, and a signed report.
Insufficient documentation may result in denial or recoupment.

ALL of the following

Modifier use
- Apply modifier 26 when reporting the professional component.
  Incorrect application of modifiers may result in denials.
- Apply modifier TC when reporting the technical component.
E/M services are not separately reportable on the same date of service unless the E/M meets the higher threshold of work above and beyond the usual MEG-associated work; when applicable follow modifier 25 guidance.
Do not unbundled E/M unless documentation supports distinct and significant additional work.

ALL of the following

Medicare and authorization considerations
- For Medicare indications that do not meet NCD, local LCD, or specific medical policy criteria, complete a Pre‑Service Organization Determination (PSOD).
  See Provider Manual for PSOD procedures.
- Authorizations and medical necessity requirements appropriate to procedure, diagnosis and frequency are still required; an authorization does not guarantee payment.
  Priority Health may reject, deny, or recoup payment if coding, billing, or documentation requirements are not followed.

Codes, Modifiers, and Documentation Requirements

MEG CPT 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)

MEG revenue codesRevenue

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

ModifiersModifier

26	Professional component modifier
TC	Technical component modifier

inv-05: Documentation and reporting threshold

OrdersAn order for MEG is required as part of the documentation workup.

Review of prior studiesDocumentation must include review and comparison of any relevant prior studies.

Identification of true spikesIdentification of true spikes on the whole‑head or large array of MEG tracings is required.

Localization of eventsDocumentation must record the location of the patient’s epileptic events (localization).

Interpretation and reportInterpretation of source and postprocessed data, data maps, and a procedure report that is prepared, reviewed, and signed are required.

inv-06: E/M reporting threshold

E/M not ordinarily separateMEG includes a cursory exam and associated discussions and should not be coded as a separate E/M on the same date.

When E/M may be reportedAn E/M may be reported only if the service is above and beyond what would be expected or associated with MEG and any associated testing.

Modifier 25 guidanceModifier 25 guidelines must be adhered to when reporting a same‑day E/M with MEG.

Authorizations and Pre-Service Determinations

Prior Authorization

PSOD required for Medicare indications outside NCD/LCD/policy

For Medicare indications that do not meet the criteria of an NCD, local LCD, or a specific medical policy, a Pre‑Service Organization Determination (PSOD) must be completed. Authorization and medical necessity requirements still apply, and an authorization does not guarantee payment — proper billing, coding, and documentation are required for reimbursement.

Complete a PSOD when Medicare indications fall outside NCD/LCD/specific policy criteria.
Obtain any required authorizations, but note authorizations do not guarantee payment; adherence to billing, coding, and documentation requirements is still required.

Policy Summary

Payerpriority health

PolicyMagnetoencephalography (MEG) reimbursement and coding

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 18, 2025

Next Review DateN/A

Key ActionFor Medicare indications not meeting NCD/LCD/policy, complete a Pre-Service Organization Determination (PSOD); authorizations do not guarantee payment.

SourceLink

On This Page

OpenPayer

Magnetoencephalography (MEG) reimbursement and coding

MEG Coverage and Billing Rules

Codes, Modifiers, and Documentation Requirements

Authorizations and Pre-Service Determinations

Key Definitions