CSHCN 2009 >29.2.16.2 Ambulatory Electroencephalogram

Ambulatory electroencephalographic monitoring is a benefit of the CSHCN Services Program with the following diagnosis codes:


Diagnosis Code	Description
2930	Delirium due to conditions classified elsewhere
2948	Other persistent mental disorders due to conditions classified elsewhere
3315	Idiopathic normal pressure hydrocephalus (INPH)
3332	Myoclonus
34500	Generalized nonconvulsive epilepsy without mention of intractable epilepsy
34501	Generalized nonconvulsive epilepsy with intractable epilepsy
34510	Generalized convulsive epilepsy without mention of intractable epilepsy
34511	Generalized convulsive epilepsy with intractable epilepsy
3452	Epileptic petit mal status
3453	Epileptic grand mal status
34540	Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy
34541	Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy
34550	Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy
34551	Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy
34560	Infantile spasms without mention of intractable epilepsy
34561	Infantile spasms with intractable epilepsy
34570	Epilepsia partialis continua without mention of intractable epilepsy
34571	Epilepsia partialis continua with intractable epilepsy
34580	Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy
34581	Other forms of epilepsy and recurrent seizures, with intractable epilepsy
34590	Unspecified epilepsy without mention of intractable epilepsy
34591	Unspecified epilepsy with intractable epilepsy
7797	Perventricular leukomalacia
78039	Other convulsions
V1085	Personal history of malignant neoplasm of brain
V1086	Personal history of malignant neoplasm of other parts of nervous system
V1240	Unspecified disorder of nervous system and sense organs
V1241	Benign neoplasm of the brain
V1249	Other disorders of nervous system and sense organs
V1369	Personal history of other congenital malformation

Procedure codes 95950, 95951, 95953, or 95956 must be used when billing for ambulatory electroencephalograms. Authorization is not required for the diagnoses listed above. All other diagnoses require authorization and documentation of medical necessity. Documentation should include the diagnosis and the specific rationale for the request. Claims for ambulatory electroencephalographic monitoring are considered for payment on appeal for diagnoses other than those listed above or if the frequency of testing exceeds the limitation.

If more than one of the above procedure codes is billed on the same day, the most inclusive procedure code is paid and all other procedure codes are denied.

Ambulatory electroencephalograms are limited to 3 for each physician for the same client per 6 months. Physicians may be reimbursed the lower of the billed amount or the amount allowed by Texas Medicaid for the procedure.