CPT Code Update

The team at Lifelines Neurodiagnostic Systems, Inc. is at the forefront of advocacy for maintaining the integrity and reimbursement value of CPT codes associated with seizure monitoring. The reimbursement for CPT code 95951 – long-duration EEG recording and monitoring – is critical to providing high quality and sustainable care for patients. To that end, we have been working diligently to form a coalition within the neurodiagnostic community to address changes to the code.

The CPT Editorial Board of the American Medical Association (AMA) met in mid-September in Chicago to review a host of proposed CPT code wording changes. The three-day event covered every medical procedure and service. Mary Anne and I applied for, and were accepted by the AMA to attend and have access and input to the actual code submissions for 95951. Due to the confidential nature of the proceedings, I can’t share all the details, but wanted to provide an update.

Two days of quite intense discussion between sponsors and interested parties resulted in a decision to place a proposal in front of the committee at the February 2018 CPT Editorial Code meeting in San Diego. This means no decision was reached and there will be no coding changes until 2020. The good news is that the AMA will likely be receptive to continue to support outpatient services, such as remote EEG monitoring. This is part of a larger trend to push outpatient vs. inpatient monitoring and treatment of health conditions.  A robust discussion was held, but it requires more time to make a final decision.

CPT change proposals are submitted by sponsoring individuals and academic societies. These proposals cover the actual procedure codes, as well as the descriptions and wording that accompany the codes. Introductory language is written, definitions of terms are defined, and example patient vignettes are developed. The agenda comprises of “tabs,” with each tab representing a proposed code change. Interested parties can apply to the AMA to have access to the actual code submissions, thus the attendance by Mary Anne and me. There were two tabs submitted by different sponsors that covered long-duration EEG recording.

The proposed 95951 code changes will be submitted to the AMA sometime late this year. The agenda for the February meeting listing the tabs will be made public in mid-December. Interested parties will be able to register their interest, agree to confidentiality, and make comment on the proposal from that time on. They will also be able to register to attend the February meeting in person and make comment. I will update you on the timeframe when the AMA calendar is posted in early December and encourage participation – our voices matter.

Click here to view the calendar.

Simon J. Griffin
Chief Executive Officer


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