Claims edit goes into effect Oct. 29, 2019

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Claims edit goes into effect Oct. 29, 2019


The following claims edit will go into effect Oct. 29, 2019:

Policy: Electroencephalogram (EEG) – Epileptic Spike Analysis


Policy description: CPT codes for “monitoring for identification and lateralization of cerebral seizure focus” (95951, 95953 or 95956) already include epileptic spike analysis. Therefore, reporting 95957 (Epileptic spike analysis) with 95951, 95953 or 95956 when performed for spike analysis represents overlapping services. CPT 95957 will be denied when billed on same date of service as 95951, 95953 or 95956.


Reference: American Academy of Neurology: (FAQs – Digital EEG Analysis (95957))


Plans affected: ConnectiCare commercial plans