Anthem Blue Cross ConnecticutCommercial Clinical Policy

CG-MED-76 Magnetic Source Imaging and Magnetoencephalography Form

Chat with GenHealth to automate any policy or prior auth task.


Magnetoencephalography (MEG)

Notes: Coverage is only provided for specific preoperative evaluations as outlined.

Indications

(555814) Is the MEG being used for preoperative evaluation of an individual with intractable focal epilepsy to identify and localize area(s) of epileptiform activity when other techniques are indeterminate? 
(555815) Is the MEG being used for preoperative localization of eloquent cortex prior to surgical resection of a brain tumor, in order to maximize preservation of eloquent cortex? 
(555816) Is the MEG being used for preoperative localization of eloquent cortex prior to surgical resection of vascular malformations, in order to maximize preservation of eloquent cortex? 

Contraindications

(555817) Is the MEG being used for any indication other than those specified as medically necessary? 

Magnetic Source Imaging (MSI)

Notes: Coverage is only provided for specific preoperative evaluations as listed.

Indications

(555818) Is the MSI being used for preoperative evaluation of an individual with intractable focal epilepsy to identify and localize area(s) of epileptiform activity when other techniques are indeterminate? 

YesNoN/A
YesNoN/A
YesNoN/A

Sign up to see the rest of the questions

Unlock the remaining questions and the full coverage workflow.

Sign up for free
Effective Date

06/28/2023

Last Reviewed

05/11/2023

Original Document

  Reference



This document addresses magnetic source imaging (MSI) and magnetoencephalography (MEG).

Note: Please see the following related document for additional information:

  • CG-MED-46 Electroencephalography and Video Electroencephalographic Monitoring

Clinical Indications

Medically Necessary:

Magnetoencephalography (MEG) is considered medically necessary for:

  1. Preoperative evaluation of individuals with intractable focal epilepsy to identify and localize area(s) of epileptiform activity when other techniques are indeterminate; or
  2. Preoperative localization of eloquent cortex prior to surgical resection of any of the following:
    1. Brain tumor in order to maximize preservation of eloquent cortex; or
    2. Vascular malformations in order to maximize preservation of eloquent cortex.

Magnetic source imaging (MSI) is considered medically necessary for:

  1. Preoperative evaluation of individuals with intractable focal epilepsy to identify and localize area(s) of epileptiform activity when other techniques are indeterminate; or
  2. Preoperative localization of eloquent cortex prior to surgical resection of any of the following:
    1. Brain tumor in order to maximize preservation of eloquent cortex; or
    2. Vascular malformations in order to maximize preservation of eloquent cortex.

Not Medically Necessary:

Magnetoencephalography (MEG) and magnetic source imaging (MSI) are considered not medically necessary for all other indications.