Local Chapter Officer
Clearwater, FL
Best answers
When reading the breakdown of special EEGs, the new Continous EEGS have replaced the old 95951, 95953. I understand it is now comprised of the Technical and Professional Component and can also include the set-up/breakdown/education if applicable.

We are doing the 2-12hrs and do provide and bill the following codes as they apply to each of our patients. 95700, 95713, 95718. So far Palmetto GBA has processed the 95700 & 95718 but denied the 95713. I am not sure why as codes 95713 and 95718 should not require modifiers as the actual wording of it being a technical or professional code is already built into it. So it doesn't make sense that maybe it might require a TC modifier. Has anyone billed Medicare for this and came across the same issue? So far the only carrier that has processed for us is BCBS Anthem and they processed our claim w/these 3 codes without an issue. Can anyone assist further on this or provide more insight?

Thank you
I am seeing the same thing here (AL). When I look up the fee schedule for the 95713 on under Medicare is states "This code is contractor priced under the Physician Fee Schedule. Please contact your local Medicare Contractor for payment amounts."

So I go to Palmetto GBA's site and pull the fee schedule and it appears as though it is not priced/allowed.

Maybe I am looking at something wrong, but I also input my claim (95718 x 1 and 95713 x 1) into Find-A-Code and no issues found with claim. Medicare has only denied the 95713 line with CO-252.
Any guidance is greatly appreciated.


CortiCare EEG Services​

An important point is that though initially there were Relative Value Units (RVUs) assigned to each of the Technical Component codes (95700-95716), from the extensive feedback CMS received during the comment period, they have held off assigning any RVUs to these codes until they gather more cost inputs from providers and other stakeholders. Therefore, they have decided to go to the “contractor-pricing” for these procedures. Making it necessary to negotiate reimbursement with each of the regional MACs (Medicare Administrative Contractors) and indeed, with other third-party payers.