Does Medicare Cover an EEG? 

Electroencephalograms (EEGs) are tests that calculate the brain’s electrical activity. These tests are non-invasive and performed by medical professionals who attach electrodes to the patient’s scalp. These sensitive metal discs pick up electrical impulses in the brain and send them through wires connected to a computer that documents the results. 

Physicians use the information collected from EEGs to find irregularities in brain activity and to help them diagnose or rule out medical disorders such as:

  • Epilepsy
  • Sleeping disorders
  • Brain tumors
  • Brain damage caused by a head injury
  • Encephalopathy and other types of brain dysfunction
  • Encephalitis (inflammation of the brain) 
  • Stroke
  • Creutzfeldt-Jakob disease

If a health care provider orders an EEG, your Medicare coverage can help you lower your out-of-pocket costs if you’re eligible for this benefit.  

How does Medicare cover an EEG? 

Medicare typically covers an EEG as a diagnostic lab test if your health care provider orders one and certifies that it’s medically necessary to diagnose, rule out, or monitor a medical condition such as epilepsy. How much you pay for your EEG depends on the type of Medicare coverage you have, and where you have the test done.

Original Medicare Part A (hospital insurance) 
If you’re enrolled in Original Medicare Part A and your physician orders an EEG while you’re an inpatient in a Medicare-affiliated hospital, Part A covers the cost of the exam. However, as a hospital inpatient, you’re responsible for paying the Part A deductible for the current benefit period before Medicare begins paying its share of your medical care costs. 

Original Medicare Part B (medical insurance) 
Medicare Part B covers 100 percent of the cost of an EEG as a diagnostic laboratory test. However, to be eligible for this benefit, the physician who orders the exam and the lab or clinic that conducts the procedure must both accept Medicare assignment. Depending on where you have your EEG done, you might need to pay a small copayment to the medical facility.  

Medicare Advantage (Part C) 
If you’re enrolled in a Medicare Advantage plan, it must at least cover all the same benefits as Original Medicare Parts A and B. Your plan may have extended coverage and extra benefits that exceed Original Medicare, so check your plan for details if you aren’t sure about your coverage. 

Your Part C plan should cover your EEG if your physician certifies that it’s medically necessary. However, depending on the type of Medicare Advantage plan you have, you might be required to go to specific testing facilities that are in your plan’s network of providers. In some cases, if you go outside the plan’s network, you must pay 100 percent of the cost out-of-pocket, so ask your provider for details if you aren’t sure. 

How much does an EEG cost without Medicare coverage? 

In the United States, costs for EEGs vary depending on where you live, who does your test, and the type of test you have done. The national average cost in this country is $970, but it can range between $200 and $3000 based on the above-mentioned variables. 

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