The member requires medication adjustments requiring ongoing monitoring (evaluating response) that cannot be safely performed on an outpatient basis.An extended stay is necessary for care for an adverse event (eg, postictal psychosis, falls, respiratory failure, status epilepticus) or.The member has experienced events so infrequent that there is a significant likelihood that they would not be detected within one week of monitoring or.Prolonged (greater than 7 days) attended EEG video monitoring in a healthcare facility is considered medically necessary for the following indications: See also CPB 0394 - Epilepsy Surgery.Īetna considers attended EEG video monitoring for driving clearance not medically necessary treatment of disease.Īetna considers attended EEG video monitoring experimental and investigational for all other indications (e.g., assessment of obstructive sleep apnea, amyotrophic lateral sclerosis (ALS), cardiac arrest, chronic fatigue, coma, headache, and assessment of the effectiveness of drug treatment in epilepsies, diagnosis of brain death, and prognosis of cardiac arrest treated with hypothermia, and newborns with hypoxic-ischemic encephalopathy treated with hypothermia not an all inclusive list) because its effectiveness for these indications has not been established.įootnote 1* Requirements for a standard EEG and neurologic examination are waived for medically necessary video EEG performed in an intensive care unit (ICU). In these cases, response to therapy can be assessed using standard EEG monitoring or ambulatory EEG monitoring.Īetna considers attended EEG video monitoring in a healthcare facility medically necessary for identification and localization of a seizure focus in persons with intractable epilepsy who are being considered for surgery. Note: Once the cause of seizures and specific type of epilepsy has been established, continued video EEG monitoring (e.g., for monitoring response to therapy or titrating medication dosages in older children and adults) is considered not medically necessary. To establish the diagnosis of epilepsy and evaluate response to treatment in very young children (3 years of age or younger) and in children with severe cognitive deficits, or older persons who are unable to communicate due to disability.To establish the specific type of epilepsy in poorly characterized seizure types where such characterization is medically necessary to select the most appropriate therapeutic regimen or. ![]() To establish the first diagnosis of a seizure disorder or
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