Effective May 1, 2021: Electroencephalogram Billing Guidelines

Date: 04/08/21

Effective May 1, 2021, the codes for Electroencephalogram (EEG) services no longer require modifiers 26 or Technical Component (TC). Claims billed with modifier TC or 26 modifier will be denied to include procedure code 95700.

Per Texas Medicaid & Healthcare Partnership (TMHP) guidelines, the codes listed below do not require a modifier. EEG procedure codes will be limited as follows:

• 95700 – Set-up, Education and Takedown
  • This code will be limited to three units per six months for each physician for the same client.
• 95705-95716 – Technical Component
  • Technical component procedure codes are limited to three studies* per six months for each physician for the same client, when medically necessary.
• 95717-95726 – Professional Component
  • Professional component procedure codes are limited to three studies* per six months for each physician for the same client, when medically necessary.

*Please note: A study includes one unit of procedure code 95700 (set-up, education and takedown) and any appropriate combination of the corresponding technical and professional codes.

For more information, please see Update to ‘Ambulatory and Long-Term Electroencephalogram Benefits to Change for Texas Medicaid October 1, 2020’.

For any questions, please call the TMHP Contact Center at 1-800-925-9126.