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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.26 Diagnostic Tests : 9.2.26.2 Ambulatory Electroencephalogram (Ambulatory EEG)

9.2.26.2
Ambulatory EEG monitoring or 24-hour ambulatory monitoring is a covered benefit for clients in whom a seizure diathesis is suspected but not defined by history, physical, and resting EEG.
Benefits are limited to 3 units (each unit 24 hours) for each physician for the same client per 6 months when medically necessary.
Use the following procedure codes to bill ambulatory EEG: 95950, 95951, 95953, and 95956.
Procedure codes 95950, 95951, 95953, and 95956 may be reimbursed when billed with the following diagnosis codes:
 
Other diagnosis codes may be considered on appeal with supporting medical documentation to the TMHP Medical Director.

Texas Medicaid & Healthcare Partnership
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