CurrentBlue Cross Blue Shield - MainePolicy C-24002

Intraoperative Neuromonitoring (IONM) reimbursement

Defines Anthem Blue Cross and Blue Shield commercial reimbursement rules for intraoperative neuromonitoring (IONM), including billing, place-of-service, and provider reporting requirements for professional providers and facilities.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyIntraoperative Neuromonitoring (IONM) reimbursement

Policy CodePolicy C-24002

Change TypeNo material change

Effective DateNov 1, 2024

Next Review DateN/A

Key ActionBill IONM codes on a CMS-1500 with place of service 19, 21, 22, or 24; UB-04 submissions will be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4allowed places of service for IONM (POS codes listed)

1document page count

0exemptions

1initial approval date recorded

Intraoperative Neuromonitoring Coverage Criteria

IONM coverage criteria

Coverage and reporting rules for intraoperative neuromonitoring (IONM) in hospital-based settings. Reimbursement is allowed when the following conditions are met:

ALL of the following

Place of Service: Reimbursement allowed when billed with POS 19 (Off campus-outpatient hospital), 21 (Inpatient hospital), 22 (On campus-outpatient hospital), or 24 (Ambulatory surgical center). Use the place of service where the member is located even if the monitoring physician is remote.
Setting requirement: IONM must be performed in a hospital setting using the place of service where the member is located.
Billing Form: IONM codes must be billed on a CMS-1500; IONM services billed on a UB-04 will be denied.
Provider reporting: IONM should not be reported by the surgeon or anesthesiologist performing the operative procedure because it is included in the global package.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyIntraoperative Neuromonitoring (IONM) reimbursement

Policy CodePolicy C-24002

Change TypeNo material change

Effective DateNov 1, 2024

Next Review DateN/A

Key ActionBill IONM codes on a CMS-1500 with place of service 19, 21, 22, or 24; UB-04 submissions will be denied.

SourceLink

On This Page

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Coding and Claim Form Requirements

IONM coding guidancemixed

Refer to IONM Coding Guidelines / Coding Grid for applicable CPT/HCPCS codes and coding rules.

Claim form requirement

Billing form requiredIONM codes must be billed on a CMS-1500; IONM services billed on a UB-04 will be denied.

Allowed places of serviceReimbursement allowed when billed with place of service 19 (Off campus-outpatient hospital), 21 (Inpatient hospital), 22 (On campus-outpatient hospital), or 24 (Ambulatory surgical center).

Reporting by operating teamIONM should not be reported by the surgeon or anesthesiologist performing the operative procedure because it is included in the global package.

Supervising physician reportingIf a provider serves as the IONM supervising physician, the supervising physician should report Modifier 26.

Facility responsibilityProvision of equipment, supplies, and technical personnel for the IONM service is the responsibility of the facility rendering the service.

Billing and Provider Reporting Requirements

Billing Rule

Billing and Provider Reporting Requirements

The Health Plan will allow reimbursement for Intraoperative Neuromonitoring (IONM) when billed by a professional provider with a place of service 19, 21, 22, or 24 unless provider, state, federal, contract and/or regulatory requirements indicate otherwise. Providers must follow the reporting and billing requirements below to avoid denial or improper payment.

IONM services must be reported using the place of service where the member is located even if the monitoring physician is located off-site. Accepted places of service are: Off campus-outpatient hospital (19), Inpatient hospital (21), On campus-outpatient hospital (22), Ambulatory surgical center (24).
IONM professional services must be billed on a CMS-1500 claim form. IONM services billed on a UB-04 (facility) claim will be denied.
IONM services should not be reported by the operating surgeon or anesthesiologist performing the operative procedure, as these services are considered included in the global surgical package.
If a provider serves as the IONM supervising physician, report Modifier 26 for the professional component.
The facility rendering the IONM service is responsible for providing equipment, supplies, and technical personnel; billing responsibility for those facility resources follows applicable facility billing rules.
Follow the IONM Coding Guidelines / Coding Grid when selecting procedure codes and modifiers.

OpenPayer

Intraoperative Neuromonitoring (IONM) reimbursement

Intraoperative Neuromonitoring Coverage Criteria

Coding and Claim Form Requirements

Billing and Provider Reporting Requirements

Key Definitions