|
24.3.11 Ambulatory Electroencephalogram
Ambulatory electroencephalographic monitoring is a benefit of the CSHCN Services Program with the following diagnosis codes:
Procedure codes 5/I/T-95950, 5/I/T-95951, 5/I/T-95953, or 5/I/T-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 three for each physician for the same client per six months. Physicians may be reimbursed the lower of the billed amount or the amount allowed by the Texas Medicaid Program for the procedure.
|
