CurrentUnitedHealthcarePolicy DIAGNOSTIC 106.13

Video Electroencephalographic (vEEG) Monitoring and Recording

Defines clinical coverage rationale and criteria for inpatient video EEG (vEEG) monitoring and recording using InterQual criteria; lists applicable CPT codes, documentation requirements, clinical evidence, and policy history/effective date for UnitedHealthcare (Oxford).

Policy Summary

PayerUnitedHealthcare

PolicyVideo Electroencephalographic (vEEG) Monitoring and Recording

Policy CodePolicy DIAGNOSTIC 106.13

Change TypeDocumentation and evidence updates

Effective Date01/01/2025

Next Review Date

Key ActionDocument that InterQual criteria for Video EEG Monitoring are met and provide required medical records per the 'Medical Records Documentation Used for Reviews' protocol.

POLICY UPDATE CHANGES

Medical Records Documentation Used for Reviews section replaced prior Required Clinical Information list with instruction to refer to the protocol titled Medical Records Documentation Used for Reviews and updated items.

Updated Clinical Evidence and References sections to reflect most current information.

01/01/2025Policy Effective Date

InterQualExternal clinical criteria used

95700-95726Referenced Procedure Codes

Coverage Summary

Policy Number: DIAGNOSTIC 106.13. Subject: Video Electroencephalographic (vEEG) Monitoring and Recording. Effective Date: January 1, 2025. Overview: This policy defines the clinical coverage rationale and criteria for inpatient vEEG monitoring and recording and states the coverage stance as covered with criteria. The policy requires that the InterQual clinical criteria for Video EEG Monitoring (pediatric or adult, as applicable) be met for inpatient admission to be considered medically necessary and directs providers to reference InterQual for the specific clinical criteria. It also specifies medical records documentation requirements per the protocol titled Medical Records Documentation Used for Reviews to support medical necessity determinations.

Key Policy Facts

Policy Effective Date01/01/2025

Coverage StanceCovered with criteria

External clinical criteria usedInterQual

Referenced Procedure CodesMultiple CPT codes (95700-95726)

Medical-Necessity Criteria

Medically Necessary Inpatient Admission for vEEG when InterQual Criteria Met

Covered when ALL of the following are met:

ALL of the following

InterQual criteria for Video EEG Monitoring (Pediatric) or Video EEG Monitoring are met (refer to InterQual CP: Procedures).
Policy delegates specific clinical criteria to InterQual; must reference InterQual content for details.
AND at least one of the following circumstances applies
- Individual is undergoing preoperative evaluation for epilepsy surgery
- Individual is not expected to have a seizure or seizure-like diagnostic event within a timeframe that is reasonable for an ambulatory VEEG recording
- Seizure provocation maneuvers are required that warrant direct observation in an inpatient setting
- Seizure medication discontinuation is required to provoke seizure for diagnostic purposes
- Seizure medication is being adjusted in such a way as to risk provoking an event that would require inpatient management

Provider Actions & Documentation Requirements

Documentation Required

Use InterQual clinical criteria for medical necessity

Document that the InterQual clinical criteria for Video EEG Monitoring (pediatric or adult, as applicable) are met and reference the InterQual content for the specific medical necessity criteria.

Reference InterQual criteria for Video EEG Monitoring (Pediatric) or Video EEG Monitoring

Documentation Required

Medical records documentation required for reviews

Provide medical records documentation per the protocol titled 'Medical Records Documentation Used for Reviews'. Include current orders and detailed information about prior and attempted seizure treatments and diagnostic testing; if inpatient is requested, provide documentation to support site of care.

Current orders
Seizure treatments and medications tried, failed, or contraindicated — include dates, duration, and reason for discontinuation
Results of all recent imaging and diagnostic tests, including routine/spot EEG, laboratory tests, and neuroimaging
Seizure semiology and frequency
If inpatient is requested, documentation to support site-of-care

Coding

Referenced Procedure Codes for vEEG (for reference only)CPT

95700	Electroencephalogram (EEG) continuous recording, with video when performed, patient education, and takedown when performed, administered in person by EEG technologist; minimum of 8 channels setup
95711	Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist; 2-12 hours; unmonitored
95712	Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist; 2-12 hours; with intermittent monitoring and maintenance
95713	Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist; 2-12 hours; with continuous, real-time monitoring and maintenance
95714	Electroencephalogram with video (VEEG); review of data, technical description by EEG technologist; each increment of 12-26 hours; unmonitored
95715	Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist; each increment of 12-26 hours; with intermittent monitoring and maintenance
95716	Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist; each increment of 12-26 hours; with continuous, real-time monitoring and maintenance
95718	Electroencephalogram (EEG); continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report; 2-12 hours of EEG recording; with video (VEEG)
95720	Electroencephalogram (EEG), continuous recording; physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording; interpretation and report after each 24-hour period; with video (VEEG)
95722	Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report; complete study; greater than 36 hours, up to 60 hours of EEG recording; with video (VEEG)

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Background & Clinical Evidence

Background: Video electroencephalographic (vEEG) monitoring is EEG monitoring synchronized with video recording that is used to distinguish epileptic from non-epileptic events, differentiate epileptic from psychogenic seizures, classify seizure types, and assist in presurgical planning. Antiepileptic drugs (AEDs) may be reduced or withdrawn during an inpatient stay to provoke seizures for diagnostic purposes. Other provocation maneuvers that may be used include sleep deprivation, fatigue, hyperventilation, photic stimulation, and exercise. The policy references international and specialty society guidelines and literature (for example ACNS guidelines, ILAE/IFCN guidance, and recent studies) that support the diagnostic yield, duration, and safety considerations for long-term video-EEG monitoring and its role in presurgical evaluation and differentiation of seizure types.

Citation	Key Finding
Timpte et al. 2023	Found 92.2% of first epileptic abnormalities observed within 24 hours; extended VEM (up to 72 hours) can be beneficial for detecting epileptic abnormalities in focal or undetermined epilepsy and to capture spontaneous seizures
Friedman & Hirsch 2009	Median time to first diagnostic event was 2 days; 35% required ≥3 days and 7% required >1 week to obtain a diagnostic event
Noe & Drazkowski 2009	Prolonged VEM considered acceptably safe: adverse events occurred in 21% but serious events were uncommon; mean time to first seizure ~2 days; mean length of stay 5 days
ILAE/IFCN 2022 guideline	Strong recommendations for inpatient long-term video-EEG monitoring to classify undetermined seizure types, differentiate epileptic vs non-epileptic events, and for presurgical evaluation of drug-resistant epilepsy

Definitions: vEEG / VEEG / Video EEG / LTM / LTVEM — Video electroencephalographic monitoring: simultaneous EEG and video recording over extended periods to correlate clinical behavior and EEG for diagnosis, seizure classification, and presurgical evaluation; LTM = long-term monitoring; LTVEM = long-term video EEG monitoring.

Revision History

01/01/2025revised (is_material: true)Latest

Replaced 'Current prescription' with 'current order'; consolidated and clarified documentation items; removed dose/frequency/physician treatment plan as separate required items — Medical Records Documentation Used for Reviews section replaced prior Required Clinical Information list with instruction to refer to the protocol titled Medical Records Documentation Used for Reviews and updated items.

01/01/2025revised (is_material: true)Latest

Consolidated and clarified required documentation: replaced multiple specific item phrasings (e.g., prior seizure treatments, neuroimaging, medications tried/failed) with streamlined instructions to include seizure treatments and medications tried/failed/contraindicated with dates, duration, and reasons; replaced 'Hospitalizations' with 'seizure-related hospitalization(s)' and 'Seizure frequency and intensity' with 'seizure semiology and frequency'; instructed to provide documentation to support site of care if inpatient requested.

01/01/2025revised (is_material: false)Latest

Evidence citations refreshed (includes 2023 and 2022 studies/guidelines) — Updated Clinical Evidence and References sections to reflect most current information.

Policy Summary

PayerUnitedHealthcare

PolicyVideo Electroencephalographic (vEEG) Monitoring and Recording

Policy CodePolicy DIAGNOSTIC 106.13

Change TypeDocumentation and evidence updates

Effective Date01/01/2025

Next Review Date

Key ActionDocument that InterQual criteria for Video EEG Monitoring are met and provide required medical records per the 'Medical Records Documentation Used for Reviews' protocol.

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