Referring Patients to the MEG Lab
Use the MEG Lab Referral Form (click to open) for submitting MEG scan requests. Also, please have patients complete the MEG Patient Questionnaire and return it to us before the scan for pre-screening. Please obtain any necessary prior determinations or pre-approvals that are needed for each scan protocol (95965, 95966, 95967). See information below and MEG Insurance Questions section for further detail and policies of specific insurance companies.
Obtaining Insurance Approvals for Patients
Most of the time, clinic/hospital staff are accustomed to checking to see if either a Pre-Certification or Prior Authorization is required before a procedure is performed. However, MEG scan CPT codes (95965, 95966, and 95967) frequently do not appear on the lists of procedures requiring Pre-Cert/Pre-Auth when inquiries are made to the insurance company either because
- many/most out-patient diagnostic procedures do not require pre-certification or
- MEG scans are not a covered benefit at all and therefore don't appear on the list of procedures requiring pre-cert or pre-auth.
For insurance providers, there are significant differences between a "Prior Determination" vs. a "Pre-Certificiation"/"Prior Authorization". They sound synonomous, but are in fact completely different processes, and patient/staff inquiries to insurance companies can be very misleading in terms of MEG coverage because the response is frequently "No pre-authorization or pre-certificiation is required for this procedure" -- even when coverage actually isn't there at all.
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