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36.4.9.2 Ambulatory Electroencephalogram (A/EEG)
A/EEG monitoring or 24-hour ambulatory monitoring is a covered benefit for patients in whom a seizure diathesis is suspected but not defined by history, physical, and resting EEG where A/EEG has been shown to be effective when used in the differential diagnosis of syncope and transient cerebral ischemic attacks not elucidated by the conventional studies.
The monitoring unit is 24 hours. Benefits are limited to three units (each unit 24 hours) for each physician for the same client per six months when medically necessary.
Use the following procedure codes to bill A/EEG: 5/I/T-95950, 5/I/T-95951, 5/I/T-95953, and 5/I/T-95956.
Procedure codes 5/I/T-95950, 5/I/T-95951, 5/I/T-95953, and 5/I/T-95956 are related. When multiple procedure codes are billed on the same day, the most inclusive code is paid and all other codes are denied.
Procedure codes 5/I/T-95950, 5/I/T-95951, 5/I/T-95953, and 5/I/T-95956 are payable when billed with the following diagnosis codes:
Other diagnosis codes may be considered on appeal with supporting medical documentation to the TMHP Medical Director.
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