It is important to use the appropriate CPT codes when seeking reimbursement by payers for covered outpatient procedures, including routine and long-term EEG studies. This article aims to provide guidance on potentially applicable CPT procedure codes for EEG while using Zeto EEG. The details we provide here are informational only, and you should consult your own billing advisors for what is required by your payors. Following this guidance is not a guarantee of coverage or reimbursement.
Billing for Routine EEG
For many reasons, a routine EEG is the most commonly performed EEG study. Choosing the correct CPT Code for routine EEG depends on two factors: how long the EEG is recorded and the patient’s state of consciousness. The EEG billing codes for the applicable time-period are set forth in Table 1.
While procedures with a length of 20-40 minutes require a different code depending on the patient’s level of consciousness, there is a single code for EEGs lasting 41 to 60 minutes, and another single EEG billing CPT code for EEGs lasting greater than 60 minutes, but not in excess of 2 hours. The codes for the longer sessions apply whether the patient is awake, drowsy, asleep, or comatose.
The CPT Code for a 41 to 60-minute routine EEG is 95813 and the code for a routine EEG more than 60 minutes in duration is 95812 (Table 1).
Table 1. CPT Codes for Routine EEG
|EEG Length||Clinical Status||CPT Code|
|Awake and drowsy||95816|
|20-40 minutes||Awake and asleep||95819|
|Coma or asleep||95822|
|41-60 minutes||Awake, drowsy, asleep, or in a coma||95813|
|>60 minutes||Awake, drowsy, asleep, or in a coma||95812|
Other EEG Billing Codes Applicable to Zeto EEG > 2 Hour Recordings
EEG recordings that last longer than 2 hours (“long-term EEG studies”) have their own set of CPT codes. EEGs greater than 2 hours, but less than 12 hours, are billed using the CPT Codes listed in Table 2. Additional CPT codes for EEGs greater than 12 hours are also available but are less applicable for Zeto’s current use case and we have not included them here.
The fact that these EEG billing codes are predicated on the time that the procedure takes makes it imperative that the clinician properly documents the reasons that the particular duration is medically necessary.
Another variable that affects the selection of the correct code for billing the professional component of a long-term EEG monitoring study is whether the EEG is video-recorded. Two EEG “professional component” CPT Codes are available for studies lasting 2 to 12 hours: 95717 is the CPT Code without video, and 95718 is the code with video.
There are also technical component CPT Codes for long-term EEG studies. The CPT Codes for long-term EEG technical components vary based on whether they are unmonitored, monitored intermittently, or monitored continuously.
Importantly, Zeto’s functionality enables providers to render remote EEG reading services and intermittently and continuously monitored EEGs that can be used to render the professional services associated with the EEG billing CPT Codes listed in Table 2.
Table 2. CPT Codes for Long-Term EEG from 2 to 12 hours
|Video||Monitoring*||CPT Code Technical Component||CPT Code Professional Component **|
** Zeto enables providers to obtain professional EEG reads via third party reading service providers
For individualized guidance on EEG billing, several third-party consulting service providers are active in the market – for questions or an introduction to a consultant familiar with Zeto, complete the form below.