Long-Term Electroencephalography (EEG)
95717 – 95720 are intended for long-term EEG monitoring services where the physician has access to the EEG data throughout the duration of the recording for inpatient studies and generates a daily report for each 24-hour segment of the recording with a summary report at the conclusion of the multi-day studies.
If these requirements are not met the correct code for the professional component would be 95721 – 95726.
Not appropriate to report these codes for ambulatory studies.
Parenthetical language following code 95718 states that (95717, 95718 may be reported a maximum of once for an entire long-term EEG service to capture either the entire time of service or the final 2-12 hour increment of a service extending beyond 24 hours).
So, you could report 95718 for the time at the conclusion of the study if less than 12 hours on the final day of recording.
Time is continuous for the start of recording. Midnights do not affect the overall duration.
95718 should only be reported at the conclusion of a study. Time counts continuously from the start of recording.
For a multi-day study, the first 24-hour period of 95720 will end during the second calendar day.
If the final day includes more than 2 hours beyond a 24-hour period, then use 95718 for that final recording day spanning between 2-12 hours.
Medicare did not assign national payment rates for the TC codes, but made them contractor priced which means that rates will be set by each regional Medicare Administrative Contractor (MAC) for their geographic jurisdiction. Each MAC will be responsible for posting their fee schedule and coverage policies.
TC codes will most frequently be used for ambulatory or in-home studies or in any scenario when the intermittent criteria are not met, you would need to report the unmonitored codes. If an EMU or ICU had 15 patients with one monitoring technologist, then the unmonitored codes would be reported for the technical services.
CPT codebook does not specify the date of service that must be reported for a multi-day studies so a good coding practice is to use the date the procedure starts.
Evaluation Management (E/M)
For 2023 E/M guidelines please see this AMA resource:
Nerve Conduction Studies
For mixed nerve conduction studies each type of study (motor with F-wave, motor without F-wave, sensory, h-reflex) performed on each nerve segment, as listed in the CPT Table of Contents as an Appendix for Listing of Sensory, Motor, & mixed Nerves of the CPT code book, counts as one study.
Add the number of studies performed to get to the appropriate code (95907-95913).
95907- 95913 are reported by the number of studies performed as this is inherent in the coding structure so the appropriate way to report these services is one unit of each depending on the number of studies performed.
Performing a sensory study and a motor study for the same nerve counts as 2 studies.
Performing a median motor + sensory & ulnar motor + sensory is counted as four studies 95908 (3-4 studies) even if only 2 nerves are studied.
Performing NCS on one nerve is not necessarily considered one study because if you perform a motor and sensory study on that one nerve, it would be counted as two studies.
Bilateral H reflex studies are reported separately as 2 studies.
Transitional Care Management (TCM) Services
CMS requires a face-to-face visit, initial patient contact, and medication reconciliation within specified time frames.
The first face-to-face visit is part of the TCM and not separately reported.
Additional face-to-face visits within the 30-day period may be reported separately.
The date of service for TCM codes is not the date of the face-to-face visit.
The time is still running until day 29 for TCM services.
The TCM charges should be submitted 30 days following discharge.
Do not submit the code until the follow up visit physically occurs.
Medicare will deny the charges if they are submitted sooner than 30 days from the date of discharge.
Within two business days of discharge, an interactive contact with the patient or caregiver must take place.
This contact can be face-to-face or by telephone or electronic means.
If you are unable to have a face-to-face follow-up within 7 to 14 days from discharge you would be unable to bill either of the TCM codes.
95717 – 95720 are intended for long-term EEG monitoring services where the physician has access to the EEG data throughout the duration of the recording for inpatient studies and generates a daily report for each 24-hour segment of the recording with a summary report at the conclusion of the multi-day studies.
If these requirements are not met the correct code for the professional component would be 95721 – 95726.
Not appropriate to report these codes for ambulatory studies.
Parenthetical language following code 95718 states that (95717, 95718 may be reported a maximum of once for an entire long-term EEG service to capture either the entire time of service or the final 2-12 hour increment of a service extending beyond 24 hours).
So, you could report 95718 for the time at the conclusion of the study if less than 12 hours on the final day of recording.
Time is continuous for the start of recording. Midnights do not affect the overall duration.
95718 should only be reported at the conclusion of a study. Time counts continuously from the start of recording.
For a multi-day study, the first 24-hour period of 95720 will end during the second calendar day.
If the final day includes more than 2 hours beyond a 24-hour period, then use 95718 for that final recording day spanning between 2-12 hours.
Medicare did not assign national payment rates for the TC codes, but made them contractor priced which means that rates will be set by each regional Medicare Administrative Contractor (MAC) for their geographic jurisdiction. Each MAC will be responsible for posting their fee schedule and coverage policies.
TC codes will most frequently be used for ambulatory or in-home studies or in any scenario when the intermittent criteria are not met, you would need to report the unmonitored codes. If an EMU or ICU had 15 patients with one monitoring technologist, then the unmonitored codes would be reported for the technical services.
CPT codebook does not specify the date of service that must be reported for a multi-day studies so a good coding practice is to use the date the procedure starts.
Evaluation Management (E/M)
For 2023 E/M guidelines please see this AMA resource:
Nerve Conduction Studies
For mixed nerve conduction studies each type of study (motor with F-wave, motor without F-wave, sensory, h-reflex) performed on each nerve segment, as listed in the CPT Table of Contents as an Appendix for Listing of Sensory, Motor, & mixed Nerves of the CPT code book, counts as one study.
Add the number of studies performed to get to the appropriate code (95907-95913).
95907- 95913 are reported by the number of studies performed as this is inherent in the coding structure so the appropriate way to report these services is one unit of each depending on the number of studies performed.
Performing a sensory study and a motor study for the same nerve counts as 2 studies.
Performing a median motor + sensory & ulnar motor + sensory is counted as four studies 95908 (3-4 studies) even if only 2 nerves are studied.
Performing NCS on one nerve is not necessarily considered one study because if you perform a motor and sensory study on that one nerve, it would be counted as two studies.
Bilateral H reflex studies are reported separately as 2 studies.
Transitional Care Management (TCM) Services
CMS requires a face-to-face visit, initial patient contact, and medication reconciliation within specified time frames.
The first face-to-face visit is part of the TCM and not separately reported.
Additional face-to-face visits within the 30-day period may be reported separately.
The date of service for TCM codes is not the date of the face-to-face visit.
The time is still running until day 29 for TCM services.
The TCM charges should be submitted 30 days following discharge.
Do not submit the code until the follow up visit physically occurs.
Medicare will deny the charges if they are submitted sooner than 30 days from the date of discharge.
Within two business days of discharge, an interactive contact with the patient or caregiver must take place.
This contact can be face-to-face or by telephone or electronic means.
If you are unable to have a face-to-face follow-up within 7 to 14 days from discharge you would be unable to bill either of the TCM codes.