Department of Neurology
MEG Insurance Questions Print E-mail

Insurance Reimbursement for MEG (MSI)

The most challenging aspect of obtaining reimbursement is working with insurance plans, especially with Managed Care Groups.  Obtaining prior approval (sometimes called a Pre-Determination or Pre-Service Review) is a multi-step process that may take a month or more to complete for health care plans which do not cover it.  The process usually begins with a Request for Prior Approval and can continue through several reviews, ending either a decision from a Medical Review Board or External Review Approval.  Because MEG/MSI procedures are still fairly new, it is not uncommon for this process to be required before an insurance company agrees to cover the procedure.

The review process involves educating the payer about how the MEG/MSI procedures will be used by physicians and neuro-surgeons in the evaluation and planning of the proposed surgical procedure, how the information may help physicians prevent neurological deficits, and how MSI can help reduce overall medical costs.  With a better understanding of the benefits of MSI, insurance companies can be willing to consider the procedures for reimbursement on a case-by-case basis by insurers, including some HMOs.  

Many third-party payers are becoming receptive to MEG, especially if the diagnostic can simultaneously reduce costs while improving surgical accuracy.  There is a steady increase in reimbursement for MSI/MEG procedures, but it can require a lengthy request-and-appeal process. 

Important Information about Medicare, Medicaid, and specific insurance plans
  • Most BlueCross/BlueShield of Alabama policies provide coverage for MEG scans without requiring Prior Determination, and Medicare* also covers MEG scans.
  • BC/BS of AL policies with WMR and PFK prefixes usually will NOT cover MEG scans.
  • "All Kids" policies do cover MEG scans. 
  • ALL PATIENTS should ensure that  NO MAJOR MEDICAL WAITING PERIODS or PRE-EXISTING CONDITION EXCLUSIONS are in effect on their policy BEFORE receiving the scan.
  • Even though The Kirklin Clinic may be a participating provider with your insurance provider, your particular plan may consider MEG specific charges as non-allowable.
  • If any services are considered as non-allowable, the patient and/or patient's parent or guarantor is responsible for any unpaid charges.
  • Out-of-state (non-Alabama) Medicaid plans normally will not cover the 20% co-pay that Medicare does not cover since they will usually not reimburse payment to out-of-state healthcare providers.
Pre-Certifications / Pre-Authorizations vs. Prior Determinations
At the Kirklin Clinic, an MEG scan is performed as an outpatient diagnostic procedure , which does not require Pre-Certification or Prior Determination for most BC/BS of AL patients and Medicare patients. However, other insurance plans frequently consider this procedure as a non-covered benefit and will require a Prior-Determination before officially approving coverage for these types of procedures.

The MEG Lab cannot guarantee insurance will pay. Important MEG Billing Contacts
Please confirm insurance benefits prior to the scan. Kirklin Clinic Billing: 877-533-0334
Certain insurance plans exclude benefits for MEG. Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Please contact the MEG Lab for specific information. Financial Counseling: 205-801-9910
Email questions: This e-mail address is being protected from spambots. You need JavaScript enabled to view it