Neurology & Pain Management Coding Alert

Question: Our neurologist spends a lot of time on computerized analyses of EEGs, but we can't get reimbursed for them. Is there a specific code for this type of analysis?

Maine Subscriber

 

Answer: You should use 95957 (digital analysis of EEG). Some carriers reimburse for it, but that varies on a state-by-state basis. A few private carriers consider it experimental in nature, while other insurers (including some Medicare carriers, such as Pennsylvania) have attached fees of about $200 to the code, which is a sizable amount. This code does include a technical (-TC) and professional (-26) component, so if the neurologist is simply interpreting a test that was performed at another location, he or she should bill 95957-26 rather than billing the entire fee. If the neurologist owns the testing equipment and employs the staff that operates it, he or she can bill for the full fee.