Understanding How You Get Paid: Part 4

The Medicare Physician Fee Schedule Final Rule (published annually in November) sets the final payment rates for the following calendar year, including new codes such as the long-term EEG monitoring codes. View the details of the final payment rates. All coding changes are effective January 1 and in this final article of the series we will look in detail on how to bill for long-term EEG monitoring services.

Starting January 1, 2020, the following CPT codes for reporting long-term EEG monitoring services will be deleted and should no longer be reported:

• 95950
• 95951
• 95953
• 95956

As a reminder, the new long-term EEG monitoring code set requires the reporting of separate codes for the physician work and the technologist work. Given the number of new codes for 2020, there is not a “1 to 1” crosswalk from the old structure to the new, meaning there will be multiple potential code options to report a service previously billed with a single CPT code.

Professional Services

Let’s first look at the professional component codes or those reported for the physician work. The code set is not specific to site of service; rather, it is differentiated by the timing of physician’s report generation:

• 95717, 95718, 95719, and 95720 are reported when diagnostic interpretations and professional reports are generated daily (even if the study extends over multiple days) and the physician has access to the data throughout the recording period.
• 95721, 95722, 95723, 95724, 95725, and 95726 are reported when the entire professional interpretation is performed after the entire study is recorded and downloaded at the completion of the recording, and the physician does not have access to the data throughout the recording period.

Code selection within these categories is dependent on the length of recording and whether simultaneous video recording is captured.

Technical Services

The technical component codes, or those reported for the technologists’ work, also can be reported in any site of services. A single code (95700) includes set up, take down (when performed) and patient/caregiver education by the EEG technologist(s) and should only be reported once per recording period.

Monitoring codes are differentiated by the duration of the recording, whether video is utilized, and the level of technologist monitoring as defined below:

• Unmonitored – Services that have no real-time monitoring by an EEG technologist during the continuous recording, or the number of patients being intermittently monitored exceeds 12.
• Intermittent monitoring (remote or on-site) – Requires an EEG technologist to perform and document real-time review of EEG data at least every 2 hours during the entire recording period. A single technologist may monitor a maximum of 12 patients concurrently.
• Continuous real-time monitoring (may be provided remotely) – Requires an EEG technologist to perform and document real-time concurrent monitoring of the EEG data during the entire recording period. A single technologist may monitor a maximum of 4 patients concurrently.

Code selection within these categories is dependent on the length of recording and whether simultaneous video recording is captured.

CPT^® is a registered trademark of the AMA. View several additional resources including:

• A full description of the long-term EEG monitoring code language
• Final 2020 Medicare values for Long-term EEG Monitoring Physician Services