Local Coverage Article Billing and Coding

Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss

A56440

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Contractor Information

Article Information

General Information

Article ID
A56440
Article Title
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss
Article Type
Billing and Coding
Original Effective Date
04/04/2019
Revision Effective Date
01/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

It has come to Novitas’ attention that the eVox® System, has been billed to Medicare using the Current Procedural Terminology (CPT) codes 95816, 95930, 95957 and 96120. CPT codes 95816, 95930, 95957 and 96120 are described as: 95816 (EEG recording including awake and drowsy), 95930 (Visual evoked potential), 95957 (Digital Electroencephalogram (EEG) analysis) and 96120 (Neurophysiological testing by computer).


Note
: CPT code 96120 was deleted effective January 1, 2019. Beginning January 1, 2019, computer assisted neurophysiological testing is reported with CPT code 96146.


Background

The following devices are listed under the U.S. Food & Drug Administration approval documents as an acquisition, display, and storage, of electrical activity of a patient’s brain including electroencephalograph (EEG) and event-related potentials (ERP) obtained by placing two or more electrodes on the head and is classified as an electroencephalograph for memory loss; Class II devices. 

  • eVox® System 
  • COGNISIONTM 

Coding Guidance

CPT codes 95816, 95930, 95957 and 96146 represent separate services for digital anlaysis of EEG, EEG, and visual and auditory evoked potential testing. The eVox® System and similar tests describe a panel of tests that should be billed using the NOC code listed in this article. These services should be reported with one(1) unit of service and not billed separately as directed by the manufacturers. The panel of test does not accurately reflect the testing of the original codes, the work units nor training inherent in these distinct codes. Therefore, it is incorrect coding to bill the individual CPT codes listed above when performing the eVox® System or other electroencephalograph testing for memory loss.

Reporting

When billing for eVox® System, COGNISIONTM, or similar such systems use the Not Otherwise Classified (NOC) CPT code 95999 - Unlisted neurological or neuromuscular diagnostic procedure. The term for the device used for this procedure (e.g. eVox® System, and COGNISIONTM) should be reported in the Remarks area of the claim for Part A and the Narrative area of the claim for Part B.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Coding Information

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
95999 Neurological procedure

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph


N/A

Group 1 Codes
CodeDescription
XX000 Not Applicable

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
999x Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2021 R2

Article revised and published on 02/11/2021 effective for dates of service on or after 01/01/2021 due to the annual CPT code updates. CPT code 92585 has been deleted. In addition, minor formatting changes have been made throughout the article. Documentation requirements have been added. Title XVIII of the Social Security Act, Section 1833(e) has been added under CMS National Coverage Policy section.

11/21/2019 R1

Article revised and published on 11/21/2019 consistent with CMS Change Request 10901. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
02/05/2021 01/01/2021 - N/A Currently in Effect You are here
11/15/2019 11/21/2019 - 12/31/2020 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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