PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AetnaAll Plans · Coverage · Medical Policy · NeurologyMedium impact

Ambulatory Electroencephalography (CPB 0425, reviewed 2026-07-07)

Effective date
Not stated in the notice
Identified
Aug 12, 2026

Summary

Aetna considers ambulatory EEG, with or without home video monitoring, medically necessary to classify seizure type in members with epilepsy when routine EEG is equivocal, to diagnose a seizure disorder when history, examination and routine EEG do not resolve the diagnostic uncertainty, and to localize the epileptogenic region during pre-surgical evaluation. These indications apply where the member has had a neurologic examination and standard EEG studies within the past 12 months. Combined ambulatory EEG and home-video recording is considered an equally acceptable alternative to ambulatory EEG alone, while ambulatory EEG for all other indications and implantable sub-scalp continuous EEG systems such as Epios and Minder for managing epilepsy are considered experimental, investigational or unproven.

Get alerts when payers change rules like this one

We check Aetna and other payers every day and email you when a change matches your specialty and state.

Get Aetna alertsPolicy Monitoring is free. No card required.

What to do

Action · 5 steps
01Billing team: Bill CPT 95700 through 95726 for ambulatory EEG only when the selection criteria are met, meaning the member has had a neurologic examination and standard EEG within the past 12 months and the indication is seizure classification, seizure disorder diagnosis, or pre-surgical localization.
02The standard EEG and neurologic examination requirement is waived for medically necessary continuous EEG performed in an intensive care unit.
03Use the ICD-10 codes G40.001 through G40.919, P90, R25.0 through R25.9, R56.01, R56.1 and R56.9 only when those selection criteria are met.
04Do not bill CPT 0956T through 0960T or 1004T through 1008T for the indications listed in this bulletin, because they are not covered for those indications.
05Ambulatory EEG monitoring longer than 7 days may be reviewed for medical necessity.

Codes mentioned

9570095705957069570795708957099571095711957129571395714957159571695717957189571995720957219572295723957249572595726G40.001G40.919P90R25.0R25.9R56.01R56.1R56.9

Original notice

Ambulatory Electroencephalography (CPB 0425, reviewed 2026-07-07)
aetna.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account