Seizure Detection Devices

Posted: January 1, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization

· Billing

· Legal References

Overview

Seizure detection devices are intended for monitoring convulsive seizures. Minnesota Health Care Programs (MHCP) covers only FDA-approved seizure detection devices.

Eligible Providers

· Medical suppliers

· Indian health services

· Federally qualified health centers

· Rural health clinics

· Hospitals

· Home health agencies

· Pharmacies

TPL and Medicare

Providers must meet any criteria, including accredition, for third party insurance or for Medicare to assist members for whom MHCP is not the primary payer.

Eligible Members

Seizure detection devices are covered for MHCP members who meet criteria of medical necessity described under Covered Services, have a history of convulsive seizures, and have active epilepsy.

Covered Services

The following codes and seizure detection devices are covered by MHCP:

· A9279: Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components, and electronics, not otherwise classified. MHCP covers one device every five years. Bill using U2 modifier.

· 99454: Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days. Refer to Telemonitoring Policy for more information. Bill using U2 modifier. MHCP only covers the standard plan subscription.

Coverage Criteria

MHCP covers seizure detection devices for MHCP members who have a medical diagnosis of convulsive seizure, have active epilepsy, and meet one of the following criteria:

· The device will likely assist in reducing bodily harm or death from convulsive seizures; or

· The device will provide data to the health care provider necessary to diagnose or treat a health condition of the member that causes the seizure activity

Noncovered Services

MHCP does not cover seizure detection devices that are not FDA approved.

Authorization

Authorization is always required for seizure detection devices and the subscription service.

Authorization documentation must include:

· The medical diagnosis, including type of seizure

· The medical necessity for monitoring these seizures

· Other types of monitoring practices the member uses

Billing

Providers are responsible to coordinate services. Review MHCP Billing Policy for general billing requirements and guidance when submitting claims.

Bill seizure detection devices using MN–ITS 837P. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics and Orthotics, and Augmentative Devices MN–ITS user guide for instructions.

· Submit the manufacturer’s suggested retail pricing (MSRP) document. If the MSRP document is not available, an invoice is acceptable documentation.

· Use modifier U2 with A9279.

· Use modifier U2 with 99454 to denote you are billing for subscription service related to seizure detection device.

Legal References

Minnesota Statutes, 256B.0625, subdivision 31 (Covered Services)
Minnesota Rules, 9505.0310 (Conditions for Payment)
Code of Federal Regulations, title 42, section 410.10 (g)(h)