Superseded Local Coverage Article Billing and Coding

Billing and Coding: Special Electroencephalography

A56771

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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To see the currently-in-effect version of this document, go to the section.

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General Information

Source Article ID
N/A
Article ID
A56771
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Special Electroencephalography
Article Type
Billing and Coding
Original Effective Date
08/01/2019
Revision Effective Date
08/17/2023
Revision Ending Date
09/30/2023
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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.

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Special Electroencephalography L33447.

Ambulatory electroencephalography (EEG) should always be preceded by a routine EEG. A routine EEG is described by Current Procedural Terminology (CPT®) codes 95812, 95813, 95816, 95819 or 95822 and refers to a routine EEG recording of less than a 24-hour continuous duration.

A routine “resting” (EEG) (as described by CPT® codes 95812, 95813, 95816, 95819 or 95822) must be performed prior to performing an ambulatory continuous EEG. A claim for the routine EEG must have been submitted to Medicare with a date of service (DOS) within 1 year of the DOS of the ambulatory EEG.

The CPT® codes contained in this article are the codes that describe the services covered per the LCD language. Claims billed with EEG services represented by CPT® codes not contained in this article require the submission of documentation and will be reviewed on a claim-by-claim basis. Note that the codes for these services now have separate coding for the professional and the technical components. Providers should bill only the component of the service which they have provided.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

*NOTE: Technical component only: CPT® code 95700 which is the code used to report set up and take down by the EEG technologist and CPT® code 95705 can be reported only once per service.

 

Group 1 Codes
Code Description
95700 ELECTROENCEPHALOGRAM (EEG) CONTINUOUS RECORDING, WITH VIDEO WHEN PERFORMED, SETUP, PATIENT EDUCATION, AND TAKEDOWN WHEN PERFORMED, ADMINISTERED IN PERSON BY EEG TECHNOLOGIST, MINIMUM OF 8 CHANNELS
95705 ELECTROENCEPHALOGRAM (EEG), WITHOUT VIDEO, REVIEW OF DATA, TECHNICAL DESCRIPTION BY EEG TECHNOLOGIST, 2-12 HOURS; UNMONITORED
95708 ELECTROENCEPHALOGRAM (EEG), WITHOUT VIDEO, REVIEW OF DATA, TECHNICAL DESCRIPTION BY EEG TECHNOLOGIST, EACH INCREMENT OF 12-26 HOURS; UNMONITORED

Group 2

(3 Codes)
Group 2 Paragraph

Professional component only

Group 2 Codes
Code Description
95717 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; WITHOUT VIDEO
95719 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; WITHOUT VIDEO
95721 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, WITHOUT VIDEO

Group 3

(5 Codes)
Group 3 Paragraph

*NOTE: A routine EEG must be performed prior to performing an ambulatory continuous EEG. A claim for the routine EEG must have been submitted to Medicare with a date of service (DOS) within 1 year of the DOS of the ambulatory EEG.

Group 3 Codes
Code Description
95812 ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; 41-60 MINUTES
95813 ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; 61-119 MINUTES
95816 ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND DROWSY
95819 ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND ASLEEP
95822 ELECTROENCEPHALOGRAM (EEG); RECORDING IN COMA OR SLEEP ONLY
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(279 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
A17.82 Tuberculous meningoencephalitis
A39.81 Meningococcal encephalitis
A42.82 Actinomycotic encephalitis
A50.42 Late congenital syphilitic encephalitis
A52.14 Late syphilitic encephalitis
A83.0 Japanese encephalitis
A83.1 Western equine encephalitis
A83.2 Eastern equine encephalitis
A83.3 St Louis encephalitis
A83.4 Australian encephalitis
A83.5 California encephalitis
A83.8 Other mosquito-borne viral encephalitis
A83.9 Mosquito-borne viral encephalitis, unspecified
A84.0 Far Eastern tick-borne encephalitis [Russian spring-summer encephalitis]
A84.1 Central European tick-borne encephalitis
A84.89 Other tick-borne viral encephalitis
A84.9 Tick-borne viral encephalitis, unspecified
A85.0 Enteroviral encephalitis
A85.1 Adenoviral encephalitis
A85.2 Arthropod-borne viral encephalitis, unspecified
A85.8 Other specified viral encephalitis
A92.2 Venezuelan equine fever
A92.31 West Nile virus infection with encephalitis
A92.5 Zika virus disease
B01.11 Varicella encephalitis and encephalomyelitis
B02.0 Zoster encephalitis
B05.0 Measles complicated by encephalitis
B06.01 Rubella encephalitis
B10.01 Human herpesvirus 6 encephalitis
B10.09 Other human herpesvirus encephalitis
B26.2 Mumps encephalitis
B94.1 Sequelae of viral encephalitis
F44.4 Conversion disorder with motor symptom or deficit
F44.5 Conversion disorder with seizures or convulsions
F44.6 Conversion disorder with sensory symptom or deficit
F44.7 Conversion disorder with mixed symptom presentation
G04.00 Acute disseminated encephalitis and encephalomyelitis, unspecified
G04.01 Postinfectious acute disseminated encephalitis and encephalomyelitis (postinfectious ADEM)
G04.02 Postimmunization acute disseminated encephalitis, myelitis and encephalomyelitis
G04.30 Acute necrotizing hemorrhagic encephalopathy, unspecified
G04.31 Postinfectious acute necrotizing hemorrhagic encephalopathy
G04.81 Other encephalitis and encephalomyelitis
G04.90 Encephalitis and encephalomyelitis, unspecified
G05.3 Encephalitis and encephalomyelitis in diseases classified elsewhere
G40.001 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus
G40.009 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus
G40.011 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus
G40.019 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus
G40.101 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus
G40.109 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus
G40.111 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus
G40.119 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus
G40.201 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus
G40.209 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus
G40.211 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus
G40.219 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus
G40.301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus
G40.309 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.311 Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.319 Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.A01 Absence epileptic syndrome, not intractable, with status epilepticus
G40.A09 Absence epileptic syndrome, not intractable, without status epilepticus
G40.A11 Absence epileptic syndrome, intractable, with status epilepticus
G40.A19 Absence epileptic syndrome, intractable, without status epilepticus
G40.B01 Juvenile myoclonic epilepsy, not intractable, with status epilepticus
G40.B09 Juvenile myoclonic epilepsy, not intractable, without status epilepticus
G40.B11 Juvenile myoclonic epilepsy, intractable, with status epilepticus
G40.B19 Juvenile myoclonic epilepsy, intractable, without status epilepticus
G40.501 Epileptic seizures related to external causes, not intractable, with status epilepticus
G40.509 Epileptic seizures related to external causes, not intractable, without status epilepticus
G40.801 Other epilepsy, not intractable, with status epilepticus
G40.802 Other epilepsy, not intractable, without status epilepticus
G40.803 Other epilepsy, intractable, with status epilepticus
G40.804 Other epilepsy, intractable, without status epilepticus
G40.811 Lennox-Gastaut syndrome, not intractable, with status epilepticus
G40.812 Lennox-Gastaut syndrome, not intractable, without status epilepticus
G40.813 Lennox-Gastaut syndrome, intractable, with status epilepticus
G40.814 Lennox-Gastaut syndrome, intractable, without status epilepticus
G40.821 Epileptic spasms, not intractable, with status epilepticus
G40.822 Epileptic spasms, not intractable, without status epilepticus
G40.823 Epileptic spasms, intractable, with status epilepticus
G40.824 Epileptic spasms, intractable, without status epilepticus
G40.833 Dravet syndrome, intractable, with status epilepticus
G40.834 Dravet syndrome, intractable, without status epilepticus
G40.89 Other seizures
G40.901 Epilepsy, unspecified, not intractable, with status epilepticus
G40.909 Epilepsy, unspecified, not intractable, without status epilepticus
G40.911 Epilepsy, unspecified, intractable, with status epilepticus
G40.919 Epilepsy, unspecified, intractable, without status epilepticus
G93.5 Compression of brain
G93.6 Cerebral edema
H55.00 Unspecified nystagmus
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.8 Other nontraumatic subarachnoid hemorrhage
I60.9 Nontraumatic subarachnoid hemorrhage, unspecified
I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical
I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical
I61.2 Nontraumatic intracerebral hemorrhage in hemisphere, unspecified
I61.3 Nontraumatic intracerebral hemorrhage in brain stem
I61.4 Nontraumatic intracerebral hemorrhage in cerebellum
I61.5 Nontraumatic intracerebral hemorrhage, intraventricular
I61.6 Nontraumatic intracerebral hemorrhage, multiple localized
I61.8 Other nontraumatic intracerebral hemorrhage
I62.9 Nontraumatic intracranial hemorrhage, unspecified
I67.1 Cerebral aneurysm, nonruptured
R00.0 Tachycardia, unspecified
R06.81 Apnea, not elsewhere classified
R25.1 Tremor, unspecified
R25.2 Cramp and spasm
R25.3 Fasciculation
R25.8 Other abnormal involuntary movements
R25.9 Unspecified abnormal involuntary movements
R29.90 Unspecified symptoms and signs involving the nervous system
R40.0 Somnolence
R40.1 Stupor
R40.20 Unspecified coma
R40.2110 Coma scale, eyes open, never, unspecified time
R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance]
R40.2112 Coma scale, eyes open, never, at arrival to emergency department
R40.2113 Coma scale, eyes open, never, at hospital admission
R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2120 Coma scale, eyes open, to pain, unspecified time
R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance]
R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department
R40.2123 Coma scale, eyes open, to pain, at hospital admission
R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2210 Coma scale, best verbal response, none, unspecified time
R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance]
R40.2212 Coma scale, best verbal response, none, at arrival to emergency department
R40.2213 Coma scale, best verbal response, none, at hospital admission
R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time
R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2310 Coma scale, best motor response, none, unspecified time
R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance]
R40.2312 Coma scale, best motor response, none, at arrival to emergency department
R40.2313 Coma scale, best motor response, none, at hospital admission
R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2320 Coma scale, best motor response, extension, unspecified time
R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance]
R40.2322 Coma scale, best motor response, extension, at arrival to emergency department
R40.2323 Coma scale, best motor response, extension, at hospital admission
R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time
R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission
R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
R40.2350 Coma scale, best motor response, localizes pain, unspecified time
R40.2351 Coma scale, best motor response, localizes pain, in the field [EMT or ambulance]
R40.2352 Coma scale, best motor response, localizes pain, at arrival to emergency department
R40.2353 Coma scale, best motor response, localizes pain, at hospital admission
R40.2354 Coma scale, best motor response, localizes pain, 24 hours or more after hospital admission
R40.2361 Coma scale, best motor response, obeys commands, in the field [EMT or ambulance]
R40.2362 Coma scale, best motor response, obeys commands, at arrival to emergency department
R40.2363 Coma scale, best motor response, obeys commands, at hospital admission
R40.2364 Coma scale, best motor response, obeys commands, 24 hours or more after hospital admission
R41.0 Disorientation, unspecified
R41.3 Other amnesia
R41.82 Altered mental status, unspecified
R45.1 Restlessness and agitation
R47.01 Aphasia
R55 Syncope and collapse
R56.1 Post traumatic seizures
R56.9 Unspecified convulsions
S06.0XAA Concussion with loss of consciousness status unknown, initial encounter
S06.0XAD Concussion with loss of consciousness status unknown, subsequent encounter
S06.0XAS Concussion with loss of consciousness status unknown, sequela
S06.1X0S Traumatic cerebral edema without loss of consciousness, sequela
S06.1X1S Traumatic cerebral edema with loss of consciousness of 30 minutes or less, sequela
S06.1X2S Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, sequela
S06.1X3S Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela
S06.1X4S Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, sequela
S06.1X5S Traumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela
S06.1X6S Traumatic cerebral edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela
S06.1XAA Traumatic cerebral edema with loss of consciousness status unknown, initial encounter
S06.1XAD Traumatic cerebral edema with loss of consciousness status unknown, subsequent encounter
S06.1XAS Traumatic cerebral edema with loss of consciousness status unknown, sequela
S06.1X9S Traumatic cerebral edema with loss of consciousness of unspecified duration, sequela
S06.2XAA Diffuse traumatic brain injury with loss of consciousness status unknown, initial encounter
S06.2XAD Diffuse traumatic brain injury with loss of consciousness status unknown, subsequent encounter
S06.2XAS Diffuse traumatic brain injury with loss of consciousness status unknown, sequela
S06.30AA Unspecified focal traumatic brain injury with loss of consciousness status unknown, initial encounter
S06.30AD Unspecified focal traumatic brain injury with loss of consciousness status unknown, subsequent encounter
S06.30AS Unspecified focal traumatic brain injury with loss of consciousness status unknown, sequela
S06.31AA Contusion and laceration of right cerebrum with loss of consciousness status unknown, initial encounter
S06.31AD Contusion and laceration of right cerebrum with loss of consciousness status unknown, subsequent encounter
S06.31AS Contusion and laceration of right cerebrum with loss of consciousness status unknown, sequela
S06.32AA Contusion and laceration of left cerebrum with loss of consciousness status unknown, initial encounter
S06.32AD Contusion and laceration of left cerebrum with loss of consciousness status unknown, subsequent encounter
S06.32AS Contusion and laceration of left cerebrum with loss of consciousness status unknown, sequela
S06.33AA Contusion and laceration of cerebrum, unspecified, with loss of consciousness status unknown, initial encounter
S06.33AD Contusion and laceration of cerebrum, unspecified, with loss of consciousness status unknown, subsequent encounter
S06.33AS Contusion and laceration of cerebrum, unspecified, with loss of consciousness status unknown, sequela
S06.34AA Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, initial encounter
S06.34AD Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, subsequent encounter
S06.34AS Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, sequela
S06.35AA Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, initial encounter
S06.35AD Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, subsequent encounter
S06.35AS Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, sequela
S06.36AA Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, initial encounter
S06.36AD Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, subsequent encounter
S06.36AS Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, sequela
S06.37AA Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, initial encounter
S06.37AD Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, subsequent encounter
S06.37AS Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, sequela
S06.38AA Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, initial encounter
S06.38AD Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, subsequent encounter
S06.38AS Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, sequela
S06.4XAA Epidural hemorrhage with loss of consciousness status unknown, initial encounter
S06.4XAD Epidural hemorrhage with loss of consciousness status unknown, subsequent encounter
S06.4XAS Epidural hemorrhage with loss of consciousness status unknown, sequela
S06.5XAA Traumatic subdural hemorrhage with loss of consciousness status unknown, initial encounter
S06.5XAD Traumatic subdural hemorrhage with loss of consciousness status unknown, subsequent encounter
S06.5XAS Traumatic subdural hemorrhage with loss of consciousness status unknown, sequela
S06.6XAA Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, initial encounter
S06.6XAD Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, subsequent encounter
S06.6XAS Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, sequela
S06.81AA Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, initial encounter
S06.81AD Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, subsequent encounter
S06.81AS Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, sequela
S06.82AA Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, initial encounter
S06.82AD Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, subsequent encounter
S06.82AS Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, sequela
S06.8A0A Primary blast injury of brain, not elsewhere classified without loss of consciousness, initial encounter
S06.8A0D Primary blast injury of brain, not elsewhere classified without loss of consciousness, subsequent encounter
S06.8A0S Primary blast injury of brain, not elsewhere classified without loss of consciousness, sequela
S06.8A1A Primary blast injury of brain, not elsewhere classified with loss of consciousness of 30 minutes or less, initial encounter
S06.8A1D Primary blast injury of brain, not elsewhere classified with loss of consciousness of 30 minutes or less, subsequent encounter
S06.8A1S Primary blast injury of brain, not elsewhere classified with loss of consciousness of 30 minutes or less, sequela
S06.8A2A Primary blast injury of brain, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.8A2D Primary blast injury of brain, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, subsequent encounter
S06.8A2S Primary blast injury of brain, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, sequela
S06.8A3A Primary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.8A3D Primary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, subsequent encounter
S06.8A3S Primary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela
S06.8A4A Primary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.8A4D Primary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, subsequent encounter
S06.8A4S Primary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, sequela
S06.8A5A Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.8A5D Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, subsequent encounter
S06.8A5S Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela
S06.8A6A Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.8A6D Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, subsequent encounter
S06.8A6S Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela
S06.8A7A Primary blast injury of brain, not elsewhere classified with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.8A8A Primary blast injury of brain, not elsewhere classified with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.8AAA Primary blast injury of brain, not elsewhere classified with loss of consciousness status unknown, initial encounter
S06.8AAD Primary blast injury of brain, not elsewhere classified with loss of consciousness status unknown, subsequent encounter
S06.8AAS Primary blast injury of brain, not elsewhere classified with loss of consciousness status unknown, sequela
S06.8A9A Primary blast injury of brain, not elsewhere classified with loss of consciousness of unspecified duration, initial encounter
S06.8A9D Primary blast injury of brain, not elsewhere classified with loss of consciousness of unspecified duration, subsequent encounter
S06.8A9S Primary blast injury of brain, not elsewhere classified with loss of consciousness of unspecified duration, sequela
S06.890S Other specified intracranial injury without loss of consciousness, sequela
S06.891S Other specified intracranial injury with loss of consciousness of 30 minutes or less, sequela
S06.892S Other specified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, sequela
S06.893S Other specified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela
S06.894S Other specified intracranial injury with loss of consciousness of 6 hours to 24 hours, sequela
S06.895S Other specified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela
S06.896S Other specified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela
S06.89AA Other specified intracranial injury with loss of consciousness status unknown, initial encounter
S06.89AD Other specified intracranial injury with loss of consciousness status unknown, subsequent encounter
S06.89AS Other specified intracranial injury with loss of consciousness status unknown, sequela
S06.9XAA Unspecified intracranial injury with loss of consciousness status unknown, initial encounter
S06.9XAD Unspecified intracranial injury with loss of consciousness status unknown, subsequent encounter
S06.9XAS Unspecified intracranial injury with loss of consciousness status unknown, sequela
N/A

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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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.

Code Description
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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.

Code Description
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
08/17/2023 R8

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added R41.3.

10/01/2022 R7

Under ICD-10 Codes that are Covered Group 1: Codes added S06.0XAA, S06.0XAD, S06.0XAS, S06.1XAA, S06.1XAD, S06.1XAS, S06.2XAA, S06.2XAD, S06.2XAS, S06.30AA, S06.30AD, S06.30AS, S06.31AA, S06.31AD, S06.31AS, S06.32AA, S06.32AD, S06.32AS, S06.33AA, S06.33AD, S06.33AS, S06.34AA, S06.34AD, S06.34AS, S06.35AA, S06.35AD, S06.35AS, S06.36AA, S06.36AD, S06.36AS, S06.37AA, S06.37AD, S06.37AS, S06.38AA, S06.38AD, S06.38AS, S06.4XAA, S06.4XAD, S06.4XAS, S06.5XAA, S06.5XAD, S06.5XAS, S06.6XAA, S06.6XAD, S06.6XAS, S06.81AA, S06.81AD, S06.81AS, S06.82AA, S06.82AD, S06.82AS, S06.8A0A, S06.8A0D, S06.8A0S, S06.8A1A, S06.8A1D, S06.8A1S, S06.8A2A, S06.8A2D, S06.8A2S, S06.8A3A, S06.8A3D, S06.8A3S, S06.8A4A, S06.8A4D, S06.8A4S, S06.8A5A, S06.8A5D, S06.8A5S, S06.8A6A, S06.8A6D, S06.8A6S, S06.8A7A, S06.8A8A, S06.8AAA, S06.8AAD, S06.8AAS, S06.8A9A, S06.8A9D, S06.8A9S, S06.89AA, S06.89AD, S06.89AS, S06.9XAA, S06.9XAD and S06.9XAS. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

10/01/2021 R6

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted G92. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/2021.

03/11/2021 R5

Under CMS National Coverage Policy updated regulation descriptions and moved regulations 42 CFR §410.28(a)(e), 42 CFR §410.32(a)(3)(i)(ii) and (iii), CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80, CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.4.4 and CMS Internet-Only Manuals, Pub. 100-03, Medicare National Coverage Determinations, Chapter 1, Part 2, §160.22 to the related LCD.

10/01/2020 R4

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted A84.8 and added G40.833, G40.834, and A84.89. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

01/01/2020 R3

Under Article Text deleted CPT® code 95827. Under Article Text, CPT/HCPCS Codes Group 1: Paragraph and CPT/HCPCS Codes Group 1: Codes deleted CPT® code 95953. Under Article Text added the last paragraph. Under CPT/HCPCS Codes Group 1: Paragraph added the technical component only note and deleted the routine EEG note. Under CPT/HCPCS Codes Group 1: Codes added CPT® codes 95700, 95705 and 95708. Added CPT/HCPCS Codes Group 2: Paragraph and CPT/HCPCS Codes Group 2: Codes sections. Under CPT/HCPCS Codes Group 2: Paragraph added Professional component only. Under CPT/HCPCS Codes Group 2: Codes added CPT® codes 95717, 95719 and 95721. Added CPT/HCPCS Codes Group 3: Paragraph and CPT/HCPCS Codes Group 3: Codes sections. Under CPT/HCPCS Codes Group 3: Paragraph added the routine EEG note. Under CPT/HCPCS Codes Group 3: Codes added CPT® codes 95812, 95813, 95816, 95819 and 95822. This revision is being made due to the Annual CPT/HCPCS update and becomes effective on 1/1/20.

10/17/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Special Electroencephalography L33447 LCD and added to this article.

08/01/2019 R1

All coding located in the Coding Information section has been removed from the related Special Electroencephalography L33447 LCD and added to this article.

 

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33447 - Special Electroencephalography
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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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
08/10/2023 10/01/2023 - N/A Currently in Effect View
07/17/2023 08/17/2023 - 09/30/2023 Superseded You are here
08/16/2022 10/01/2022 - 08/16/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • •Special Electroencephalography
  • •EEG