Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

1. Magnetoencephalography is a noninvasive functional imaging technique which records the weak magnetic forces associated with the brain’s electrical activity. 
2. This sophisticated technique is sometimes helpful in localizing brain function in patients preparing to undergo brain surgery for intractable epilepsy.
3. This technology is covered in patients who meet the medical policy criteria for intractable epilepsy.

1. Magnetic source imaging (MSI) or magnetoencephalography (MEG) are considered medically necessary for pre-surgical evaluation in persons with intractable focal epilepsy to identify and localize areas of epileptiform activity, when discordance or continuing questions arise from among other techniques designed to localize a focus.
2. MSI or MEG is considered experimental and investigational when used as a stand-alone test or as the first order of test after clinical and routine electroencephalographic (EEG) diagnosis of epilepsy.

Codes Used In This BI:

95965 Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (e.g., epileptic cerebral cortex localization)
95966 Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, single modality (e.g., sensory, motor, language, or visual cortex localization)
95967 Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, each additional modality (e.g., sensory, motor, language, or visual cortex localization) (List separately in addition to code for primary procedure)
S8035 Magnetic source imaging
 

1.    MSI or MEG is considered experimental and investigational for the following indications (not an all inclusive list):

·         Evaluation of Alzheimer`s disease

·         Evaluation of autism

·         Evaluation of brain tumors

·         Evaluation of cognitive and mental disorders

·         Evaluation of developmental dyslexia

·         Evaluation of multiple sclerosis

·         Evaluation of Parkinson`s disease

·         Evaluation of schizophrenia

·         Evaluation of stroke rehabilitation

·         Evaluation of traumatic brain injury

·         Fetal neurological assessment.

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24. Korvenoja A, Kirveskari E, Aronen HJ, et al. Sensorimotor cortex localization: Comparison of magnetoencephalography, functional MR imaging, and intraoperative cortical mapping. Radiology. 2006;241(1):213-222.
25. Grover KM, Bowyer SM, Rock J, et al. Retrospective review of MEG visual evoked hemifield responses prior to resection of temporo-parieto-occipital lesions. J Neurooncol. 2006;77(2):161-166.
26. Pelletier I, Sauerwein HC, Lepore F, et al. Non-invasive alternatives to the Wada test in the presurgical evaluation of language and memory functions in epilepsy patients. Epileptic Disord. 2007;9(2):111-126.
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