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The result of the review by the American Medical Association (AMA) was to grant MEG a Current Procedural Terminology (CPT) I code. A Category I CPT code describes a procedure or service identified with a five-digit code and descriptor nomenclature.
In developing new Category I CPT codes, the Advisory Committee of the AMA requires:
(1) that the service receive approval from the FDA for the specific use of the device; (2) that the procedure is performed across the country in multiple locations; (3) that many physicians perform the service/procedure; and (4) that the clinical efficacy of the service/procedure has been well established and documented.
The three CPT I codes of the MEG technology are:
95965: MEG recording and analysis for spontaneous brain magnetic activity. This CPT code is used for epileptic cerebral cortex localization.
95966: MEG for evoked magnetic fields, single modality. This CPT code is used for sensory, motor, language, or visual cortex localization.
95967: MEG for evoked magnetic fields, each additional modality (ie. Sensory, motor, language, or visual cortex localization) - to be listed separately in addition to code 95966 for primary procedure. |
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Thus the above CPT codes, cover three MEG procedures: presurgical functional mapping prior to tumor resection, assessment of brain trauma, and epilepsy localization. Since MEG procedures are normally performed in a combination, the reimbursement rates often result in billable fees for hospitals in the US between $4,000 and $5,000 USD per patient for epilepsy localization and between $2,000 and $3,000 USD per patient for pre-surgical functional mapping. |
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