95961 Insurance Policy Changes

Quantitative EEG (Brain Mapping) (CPB 0221, reviewed 2026-04-14)

Aetna's Quantitative EEG (qEEG/Brain Mapping) policy (CPB 0221, effective 2026-04-14) establishes strict medical necessity criteria, covering qEEG only as an adjunct to traditional EEG for seven specific clinical scenarios (ambulatory recording, ICU monitoring, cerebrovascular evaluation, dementia/encephalopathy diagnosis, seizure screening, and pre-surgical epilepsy assessment). All other indications—including ADHD, depression, autism, anxiety, PTSD, concussion, and 30+ other diagnoses—are classified as experimental/investigational and not covered. Billing teams must immediately update claim submission logic to deny qEEG claims lacking one of the seven approved indications.