Billing and Coding

Thanks to the combined advocacy of members of the American Epilepsy Society, the National Association of Epilepsy Centers, the American Academy of Neurology, and the American Clinical Neurophysiology Society, the final schedule reflects CMS recognition that its original proposal devalued long-term EEG monitoring services. 

The final rule reflects an increase from the original proposal in the rates for several of the professional component (physician work) codes.

While AES is disappointed that the final rates still represent overall decreased reimbursement, the final rule represents acceptance of the original RUC recommended values for these codes.  In addition, CMS agreed to carrier price all of the TC codes in 2020 and will accept additional data as it plans to set national prices in future rule-making.

For additional analysis and detail on the long-term EEG codes please see the NAEC fact sheet.

The final rule issued on November 1, 2019, can be accessed here.

NAEC/AES Session on New Long Term EEG Codes – Slides Available

NAEC and AES partnered to present details of the new long-term EEG coding structure for 2020 at a coding session during the AES Annual Meeting in Baltimore, MD.  The information presented by Drs. Nathan Fountain, Gregory Barkley, Marc Nuwer, and Susan Herman covered the history, reasons, and process for the coding changes, the new coding structure and Medicare values/payment, case studies showing how to use the new codes and next steps for the medical societies.  A copy of the slide set can be found here.

Coding Resources

  • Centers for Medicare and Medicaid: The Centers for Medicare and Medicaid (CMS) provides information to providers and facilities on regulations and other resources. 
  • National Association of Epilepsy Centers: Information regarding public health issues, policies, and regulations that impact epilepsy care management, as well as a listing of epilepsy centers in the US, can be accessed here.