Transmission of the EEG by telephone, radio, or cable is considered medically necessary when the closest medical facilities are located in remote areas which lack trained EEG interpreters for patients with the following indications:
· Altered consciousness, such as stuporous, semicomatose, or comatose states;
· Atypical seizure variants in patients experiencing bizarre, distressing symptoms as seen with “spike and wave stupor” or other forms of seizure disorders;
· Head injury, where a subdural hematoma may be identified; or
· Differentiation of complicated migraine with epilepsy-like symptoms (e.g., auras, alterations in level of consciousness) from true seizure disorders.
Radio and cable telemetry of the EEG is considered medically necessary with prior approval for an:
· EEG recording during provocation testing (e.g., withdrawal of anticonvulsant medications), which can be safely undertaken only in the immediate proximity of emergency medical personnel and technology; and
· EEG recording attempting to localize the seizure focus prior to surgery when ambulation is desirable (e.g., when seizures are triggered by specific environmental stimuli or daily events).
Telephone transmission of the EEG to determine electrocerebral silence, i.e., brain death, is considered investigational.
Twenty-four hour ambulatory cassette-recorded EEGs are medically necessary with prior approval in the following circumstances:
· When used in conjunction with ambulatory electrocardiogram (ECG) recordings for seizures suspected to be of cardiogenic origin;
· When used in conjunction with electro-oculogram (EOG) and electromyogram (EMG) recordings for suspected seizures of sleep disturbances;
· When used for quantification of seizures in patients who experience frequent absence seizures; and
· When used in documenting seizures that are precipitated by naturally occurring cyclic events or environmental stimuli that are not reproducible in the hospital or clinic setting.
Twenty-four hour ambulatory cassette-recorded EEGs are considered investigational in the following circumstances:
· For the study of neonates or unattended, noncooperative patients;
· In localization of seizure focus/foci when the seizure symptoms and/or other EEG recordings indicate the presence of bilateral foci or rapid generalization; and
· For final evaluation of patients who are being considered as candidates for resective surgery.
Video/EEG monitoring is considered medically necessary with prior approval when used to confirm the diagnosis of cases of complex seizures where treatment is defined by the seizure type. EEG video monitoring is useful for patients where a diagnosis could not be made on the basis of a neurological examination, routine EEG reporting, and ambulatory cassette EEG monitoring.
