Medicare Coverage of an EEG (Electroencephalogram)
Type of Medical Service
Diagnostic test of electrical currents in the brain
Medicare Part B or a Medicare Part C plan covers EEG (electroencephalogram) testing.
If you have a Medicare Part C Medicare Advantage plan: Co-payments for Medicare Part C Medicare Advantage plans may be different from those for Medicare Part B. To find out whether your plan has different co-payments for EEG testing, contact the plan directly.
What Medicare Pays
For an EEG performed in a hospital outpatient department, Medicare Part B pays the full Medicare-approved amount, except for a patient co-payment. For an EEG in any other setting, Medicare Part B pays 80 percent of the Medicare-approved amount.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
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