Anthem Blue Cross Connecticut CG-MED-76 Magnetic Source Imaging and Magnetoencephalography Form
This procedure is not covered
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:
- Preoperative evaluation of individuals with intractable focal epilepsy to identify and localize area(s) of epileptiform activity when other techniques are indeterminate; or
- Preoperative localization of eloquent cortex prior to surgical resection of any of the following:
- Brain tumor in order to maximize preservation of eloquent cortex; or
- Vascular malformations in order to maximize preservation of eloquent cortex.
Magnetic source imaging (MSI) is considered medically necessary for:
- Preoperative evaluation of individuals with intractable focal epilepsy to identify and localize area(s) of epileptiform activity when other techniques are indeterminate; or
- Preoperative localization of eloquent cortex prior to surgical resection of any of the following:
- Brain tumor in order to maximize preservation of eloquent cortex; or
- 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.
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