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Magnetic Source Imaging/Magnetoencephalography (CPB 0279, reviewed 2026-04-14)

Aetna·Neurology, Neurosurgery, Psychiatry +1 more·Radiology
Effective date
Apr 14, 2026
We identified it
Aug 14, 2026
Days to comply

Summary

Aetna's updated CPB 0279 policy (effective 2026-04-14) clarifies coverage for Magnetic Source Imaging/Magnetoencephalography (MEG). MEG is covered only for pre-surgical evaluation in intractable focal epilepsy when discordance exists from other localization techniques. MEG is not covered as a standalone test, first-line test, or for 30+ other neurological and psychiatric indications, all classified as experimental/investigational.

Action Required

Action needed
By April 14, 2026: Billing team must implement the following in the claims processing system and EMR: (1) Update billing rules to REQUIRE prior authorization for CPT codes 95965, 95966, 95967, and HCPCS code S8035 when billed with any ICD-10 code OTHER than G40.011–G40.019, G40.111–G40.119, G40.211–G40.219, G40.311, G40.319, G40.A11–G40.A19, G40.B11–G40.B19, G40.411–G40.419, G40.811–G40.89, G40.911–G40.919 (intractable epilepsy only). (2) Add denial rule: Any claim for MEG with non-intractable epilepsy codes (G40.101–G40.109, G40.201–G40.209, G40.301, G40.309, G40.A01–G40.A09, G40.B01–G40.B09, G40.401–G40.409, G40.501–G40.509, G40.801–G40.802, G40.901–G40.909) or with brain tumor, Alzheimer's disease, Parkinson's disease, multiple sclerosis, migraine, chronic pain, traumatic brain injury, ADHD, autism, schizophrenia, or other psychiatric/neurological diagnoses will be automatically denied as experimental/investigational. (3) Provider education: Communicate to neurology and neurosurgery staff that MEG requires documentation of: (a) confirmed intractable focal epilepsy diagnosis, (b) completion of standard EEG and neuroimaging, (c) discordance or continuing questions from prior localization studies. (4) Update encounter templates and order entry systems to include required clinical justification fields. Failure to implement will result in claim denials and patient financial liability.

Affected Billing Codes

95965
95966
95967
S8035