Topographic Brain Mapping Form

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 1 (401) 274-4848 WWW.BCBSRI.COM EFFECTIVE DATE: 04|20|2010 POLICY LAST REVIEWED: 01|21|2026 OVERVIEW Topographic brain mapping (TBM) is an extension of conventional electroencephalography. MEDICAL CRITERIA Not applicable PRIOR AUTHORIZATION Not applicable
POLICY STATEMENT Medicare Advantage Plans Topographic brain mapping is not covered as the evidence is insufficient to determine that the technology results in an improvement in the net health outcome. Commercial Products Topographic brain mapping is considered not medically necessary as the evidence is insufficient to determine that the technology results in an improvement in the net health outcome. COVERAGE Benefits may vary between groups/contracts. Please refer to the appropriate section of the Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable not medically necessary/not covered benefits/coverage. BACKGROUND Topographic brain mapping (TBM), sometimes referred to as brain electrical activity mapping (BEAM), involves the computerized analysis and topographic display of electroencephalogram (EEG) rhythms and evoked potential data on a color video screen. A wide assortment of maps can be created to represent different measurement patterns. The purpose of TBM is to identify patterns that distinguish pathological groups from normal ones. There is no scientific literature to support the use of TBM, therefore, topographic brain mapping is considered not medically necessary.
CODING Medicare Advantage Plans and Commercial Products The following HCPCS code(s) is not covered for Medicare Advantage Plans and not medically necessary for Commercial Products: S8040 Topographic brain mapping RELATED POLICIES Not applicable PUBLISHED Provider Update, March 2026 Provider Update, April 2025 Provider Update, April 2024 Medical Coverage Policy | Topographic Brain Mapping

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW.BCBSRI.COM

Provider Update, April 2023 Provider Update, July 2022

REFERENCES

1. American Academy of Neurology and the American Clinical Neurophysiology Society. Assessment of digital EEG, quantitative EEG, and EEG brain mapping. Neurology;1997;49:277-292.

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