EEG/ERP Payment EOB's
MaDPI offers these Explanation of Benefits (EOB) with the caveat that insurance company practice and procedures differ as do the additional services and billing that doctors perform. For example, some bill for the neuropsychological assessment prior to the EEG, some even have a psychologist perform this testing leading to increased billing, some docs bill for accessing data from a computer, while others do not. Some may video the EEG, awake and asleep, etc. Some doctors bill for the EEG reads. Adding EVP (Evoked Potential - mild electrical stimulation across the head) to the EEG is a valuable tool and is billable as a separate fee.
Properly documented medical necessity and correct ICD-10 also greatly impact claim acceptance.
The Behavioral Health Assessments billed to Medicare and other carriers show that EEG when done correctly can be compensable.
Ultimately, it is up to the doctor and his/her billing and coding consultants to understand their practice nuances and complexities and as such the various billing opportunities available.
A documented payment scenario from a client is as follows*:
99212 - Pre Test OV: ACE/Cranial Nrv/Bess Tests - $95.00
99211 - Post Test OV: EEG/ERP Test review - $50.00
95816 - EEG Awake and drowsy - $587.00 ($600 billed)
Total Insurance Paid = $732.00 less test cost ($265) = $467 net profit per test protocol
*Results may vary. Always check with your licensing board & billing experts.