CommercialCoverageMedium impact
Grid Monitoring and Intraoperative Electroencephalography (CPB 0289, reviewed 2026-04-17)
Aetna·Neurosurgery, Cardiothoracic Surgery, Vascular Surgery +2 more·Medical Policy
Effective date
Apr 17, 2026
We identified it
Aug 16, 2026
Summary
Aetna's updated Grid Monitoring and Intraoperative EEG policy (CPB 0289) establishes clear medical necessity criteria for intraoperative EEG during carotid artery surgery, intracranial vascular procedures, and parietal tumor resection, and for grid monitoring in intractable seizure cases. The policy explicitly excludes coverage for intraoperative EEG used to monitor anesthetic depth and designates it as experimental, as well as excludes grid monitoring for non-listed indications. Billing teams must verify medical necessity documentation before submitting claims and apply the specific covered CPT/HCPCS codes only when selection criteria are met.
Action Required
By May 17, 2026, the billing team must: (1) Update billing software to enforce prior authorization rules that require claims for CPT 95812, 95813, 95822, 95829, 95940, 95941, 95955, 95958, 95961, 95962, G0453, and S8040 to include documentation of medical necessity matching the covered indications (carotid artery surgery, intracranial vascular procedures, parietal tumor resection, lesion near eloquent cortex, intractable seizures, or WADA testing). (2) Reject or deny claims for intraoperative EEG (CPT 95812, 95813, 95822, 95940, 95941) when documentation indicates the procedure was used solely for monitoring anesthetic depth—this is considered experimental and not separately reimbursable. (3) Create a validation checklist in the EMR/billing system to require providers to document which specific covered indication applies before submitting claims. (4) Train billing staff to identify and flag claims with ICD-10 code F05 (post-operative delirium) paired with intraoperative EEG codes—these will be denied as experimental. (5) For grid monitoring claims (CPT 95829, S8040), verify that the claim includes documentation confirming the center has expertise and experience, especially for pediatric cases. Failure to validate medical necessity will result in claim denials under this policy.