CurrentBlue Cross Blue Shield - MassachusettsPolicy 211

Intraoperative Neurophysiologic Monitoring and Evoked Potential Testing

Defines medical necessity criteria, prior authorization requirements, and covered CPT/HCPCS/ICD-10 codes for intraoperative neurophysiologic monitoring (IONM) and related evoked potential testing for commercial and Medicare members. Also lists indications considered investigational or not medically necessary and inpatient/outpatient authorization rules.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyIntraoperative Neurophysiologic Monitoring and Evoked Potential Testing

Policy CodePolicy 211

Change TypeRevised (MEP expansion) / Added (spinal instrumentation) / Clarified (billing)

Effective Date

Next Review Date

Key ActionSubmit prior authorization requests via Authorization Manager and document qualifying ICD-10 diagnoses and any high-risk features when requesting IONM.

POLICY UPDATE CHANGES

Motor evoked potentials expanded to include additional medically necessary indications.

New indication for spinal instrumentation requiring screws or distraction added.

Coding clarification that both EMG CPT code and intraoperative monitoring code are needed if EMG used for IONM.

Policy allowed prior authorization requests via Authorization Manager.

Annual policy review with literature updates; policy statements unchanged.

3Testing categories covered (IONM, VEP, SSEP/MEP)

3CPT/HCPCS primary IONM codes listed

1Investigational CPT codes

120+ICD-10 diagnosis codes listed (approx.)

Coverage Summary

This policy addresses intraoperative neurophysiologic monitoring (IONM) modalities including SSEP (somatosensory evoked potentials), MEP (motor evoked potentials), brainstem auditory evoked potentials (BAEP), EMG (electromyography), EEG, and electrocorticography, and also covers evoked potential testing such as VEP, SSEP, and MEP. It applies where monitoring or testing is performed because the results will be used to guide clinical management or to help prevent nerve injury during high‑risk surgery (for example intracerebral, spinal, vascular, or other procedures that place neural structures at risk).

Policy stance: coverage is mixed — certain IONM modalities and evoked potential tests are considered medically necessary when the specified medical necessity criteria are met (real‑time monitoring with continuous communication to the surgical team and listed indications), while other uses (including many applications of VEP intraoperatively and certain monitoring approaches) are considered not medically necessary or investigational when criteria are not met.

Scope summary: defines medical necessity criteria, prior authorization requirements, and lists covered CPT/HCPCS/ICD‑10 codes for IONM and related evoked potential testing, and identifies investigational or not medically necessary indications.

Selected statistics and coding summary

Testing categories coveredIONM, VEP, SSEP/MEP

Covered CPT codes95930 (VEP); 95925–95927,95938 (SSEP); 95928–95929,95939 (MEP); 95940 (IONM) when criteria met

Investigational CPT codes0464T (VEP for glaucoma) considered investigational

Indications with sufficient evidenceSpinal instrumentation requiring screws/distraction; high‑risk thyroid/parathyroid surgery for RLN protection; intracranial, spinal, vascular procedures

Policy revisions expanding MEP indicationsPolicy revised effective 11/1/2024 to expand MEP indications

Medical-Necessity Criteria

Intraoperative Neurophysiologic Monitoring (IONM) - Medically Necessary

May be considered MEDICALLY NECESSARY when ALL of the following are met:

ALL of the following

Monitoring is being conducted in real-time and interpretation is continuously communicated to surgical team.
ALL of the following
- Cranial Nerve
  - Spinal, intracranial, vascular procedures (including spinal instrumentation requiring screws or distraction).
  - Head and neck surgery (e.g., resection of skull base tumor, resection of tumor involving a cranial nerve, cavernous sinus tumor, neck dissection, epileptogenic brain tumor/tissue resection).

Coding

IONM CPT Codes coveredCPTCovered

95940	Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure).
95941	Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure). Note: 95941 is considered investigational for Medicare HMO Blue and Medicare PPO Blue.

IONM HCPCS Codes coveredHCPCSCovered

G0453

Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure).

Evoked Potential / SSEP CPT Codes coveredCPT

No codes listed

EMG during IONM (billing guidance)mixed

Refer

When electromyography (EMG) is utilized as part of intraoperative neurophysiologic monitoring, the appropriate EMG CPT code (refer to policy #701) must be utilized in conjunction with codes 95940; 95941 or G0453 above.

Covered CPTCPTCovered

95930

Somatosensory evoked potential (SSEP) testing (example code included in policy for informational purposes).

Investigational / Not coveredCPTExperimental

0464T

Investigational code listed as not covered for indication per policy (included for informational/claim-scrubbing purposes).

ICD-10 Procedure Codes informationalICD-10

4A1004G	Monitoring of Central Nervous Electrical Activity, Intraoperative, Open Approach.
4A1034G	Monitoring of Central Nervous Electrical Activity, Intraoperative, Percutaneous Approach.
4A1074G	Monitoring of Central Nervous Electrical Activity, Intraoperative, Via Natural or Artificial Opening.
4A1084G	Monitoring of Central Nervous Electrical Activity, Intraoperative, Via Natural or Artificial Opening Endoscopic.
4A10X4G	Monitoring of Central Nervous Electrical Activity, Intraoperative, External Approach.
4A1104G	Monitoring of Peripheral Nervous Electrical Activity, Intraoperative, Open Approach.
4A1134G	Monitoring of Peripheral Nervous Electrical Activity, Intraoperative, Percutaneous Approach.
4A1174G	Monitoring of Peripheral Nervous Electrical Activity, Intraoperative, Via Natural or Artificial Opening.
4A1184G	Monitoring of Peripheral Nervous Electrical Activity, Intraoperative, Via Natural or Artificial Opening Endoscopic.

ICD-10 Diagnosis Codes coveredICD-10Covered

R40.2121	Coma: Score on Glasgow coma scale, eye response 2, verbal response 1, motor response 2, initial encounter (example).
R40.2122	Coma: GCS eye 2 verbal 1 motor 2, subsequent encounter.
R40.2123	Coma: GCS eye 2 verbal 1 motor 2, sequela.
R40.2124	Coma: GCS eye 2 verbal 1 motor 2, chronic.

ICD-10 Diagnosis Codes - Contusion etc. neutralICD-10

S06.894A	Other intracranial injury with loss of consciousness of unspecified duration, initial encounter.
S06.9X5D	Unspecified intracranial injury with loss of consciousness of unspecified duration, subsequent encounter.
S06.9X5S	Unspecified intracranial injury with loss of consciousness of unspecified duration, sequela.
S06.9X6A	Unspecified intracranial injury with loss of consciousness of unspecified duration, initial encounter.
S06.9X6D	Unspecified intracranial injury with loss of consciousness of specified duration, subsequent encounter.
S06.9X6S	Unspecified intracranial injury with loss of consciousness of specified duration, sequela.
S06.9X9A	Unspecified intracranial injury, initial encounter.
S06.9X9D	Unspecified intracranial injury, subsequent encounter.
S06.9X9S	Unspecified intracranial injury, sequela.
S09.8XXA	Other specified injuries of head, initial encounter.

1–10 of 15

1/2

ICD-10 Diagnosis Codes - Cervical/Spine related neutralICD-10

S14.104D	Injury of nerve root of cervical spine, subsequent encounter.
S14.104S	Injury of nerve root of cervical spine, sequela.
S14.105A	Injury of nerve root of cervical spine, initial encounter.
S14.105D	Injury of nerve root of cervical spine, subsequent encounter.
S14.105S	Injury of nerve root of cervical spine, sequela.
S14.106A	Injury of other nerves at neck level, initial encounter.
S14.106D	Injury of other nerves at neck level, subsequent encounter.
S14.106S	Injury of other nerves at neck level, sequela.
S14.107A	Injury of sympathetic nerves at neck level, initial encounter.
S14.107D	Injury of sympathetic nerves at neck level, subsequent encounter.

1–10 of 18

1/2

ICD-10 Diagnosis Codes - Traumatic brain injury series neutralICD-10

S06.1X6D	Traumatic cerebral edema with loss of consciousness of unspecified duration, subsequent encounter.
S06.1X6S	Traumatic cerebral edema with loss of consciousness of unspecified duration, sequela.
S06.1X7A	Diffuse traumatic brain injury with LOC of 1-5 hours, initial encounter.
S06.1X8A	Diffuse traumatic brain injury with LOC of 6-24 hours, initial encounter.
S06.1X9A	Diffuse traumatic brain injury with LOC of more than 24 hours without return to pre-existing conscious level, initial encounter.
S06.1X9D	Diffuse traumatic brain injury with LOC >24 hours without return, subsequent encounter.
S06.1X9S	Diffuse traumatic brain injury with LOC >24 hours without return, sequela.

ICD-10 Diagnosis Codes - Additional TBI and spine codes neutralICD-10

S06.2X1D	Diffuse traumatic brain injury with loss of consciousness of unspecified duration, subsequent encounter.
S06.2X1S	Diffuse traumatic brain injury with loss of consciousness of unspecified duration, sequela.
S06.2X2A	Diffuse traumatic brain injury with prolonged LOC, initial encounter.
S06.2X2D	Diffuse traumatic brain injury with prolonged LOC, subsequent encounter.
S06.2X2S	Diffuse traumatic brain injury with prolonged LOC, sequela.
S06.2X3A	Other specified traumatic intracranial hemorrhage, initial encounter.
S06.2X3D	Other specified traumatic intracranial hemorrhage, subsequent encounter.
S06.2X3S	Other specified traumatic intracranial hemorrhage, sequela.
S06.2X4A	Traumatic subarachnoid hemorrhage, initial encounter.
S06.2X4D	Traumatic subarachnoid hemorrhage, subsequent encounter.

1–10 of 22

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ICD-10 Diagnosis Codes - Additional series neutralICD-10

S06.301D	Diffuse traumatic brain injury, subsequent encounter.
S06.301S	Diffuse traumatic brain injury, sequela.
S06.302A	Focal traumatic brain injury, initial encounter.
S06.302D	Focal traumatic brain injury, subsequent encounter.
S06.302S	Focal traumatic brain injury, sequela.
S06.303A	Other specified intracranial injury, initial encounter.
S06.303D	Other specified intracranial injury, subsequent encounter.
S06.303S	Other specified intracranial injury, sequela.
S06.304A	Traumatic subarachnoid hemorrhage, initial encounter.
S06.304D	Traumatic subarachnoid hemorrhage, subsequent encounter.

ICD-10 Diagnosis Codes - Cervical nerve series neutralICD-10

S14.109S	Injury of other structures at neck level, sequela.
S14.111A	Injury of nerves at thoracic level, initial encounter.
S14.111D	Injury of nerves at thoracic level, subsequent encounter.
S14.111S	Injury of nerves at thoracic level, sequela.
S14.112D	Injury of other nerves at thoracic level, subsequent encounter.
S14.112S	Injury of other nerves at thoracic level, sequela.
S14.113A	Injury of sympathetic nerves at thoracic level, initial encounter.
S14.113D	Injury of sympathetic nerves at thoracic level, subsequent encounter.
S14.113S	Injury of sympathetic nerves at thoracic level, sequela.

Billing note: When EMG is used as part of intraoperative neurophysiologic monitoring, both the appropriate EMG CPT code (see policy #701) and the IONM service codes (95940, 95941, or G0453) must be billed together as applicable. Inclusion of codes in this policy is informational and does not guarantee coverage; medical necessity criteria and member contract benefits must be met to determine coverage.

Provider Actions & Operational Requirements

Prior Authorization

Precertification/Preauthorization Required for Inpatient

Precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient.

Prior Authorization

Prior Authorization Required for Outpatient IONM

Prior authorization is required for outpatient IONM codes 95940, 95941 and G0453 for Commercial Managed Care (HMO and POS), PPO and Indemnity.

95940
95941
G0453
Commercial Managed Care (HMO and POS), PPO, Indemnity

Background, Evidence & Definitions

This policy covers multiple IONM modalities: SSEP (somatosensory‑evoked potentials), MEP (motor‑evoked potentials), BAEP (brainstem auditory‑evoked potentials), EMG (electromyography), EEG, and electrocorticography. These techniques are described as methods to assess the functional integrity of sensory and motor pathways and cranial/peripheral nerves during procedures that put the spinal cord, brain, or cranial/peripheral nerves at risk.

Evoked potential testing covered by the policy includes VEP (visual‑evoked potentials), SSEP, and MEP. VEPs may be medically necessary for diagnostic evaluation or monitoring of optic pathway disorders (for example multiple sclerosis or suspected optic nerve/chiasm/radiation disorders not explained by imaging), while SSEP and MEP testing are considered medically necessary when the results will be used to guide clinical management in specified conditions (e.g., acute anoxic encephalopathy, coma following diffuse brain injury, unexplained myelopathy, demyelinating disease, suspected brain death, and spinal cord lesions when surgical decisions depend on testing).

Policy intent: IONM and evoked potential testing are intended to be used when monitoring/testing will influence intraoperative or perioperative management or when monitoring can help prevent nerve injury in high‑risk surgical settings (examples listed include spinal instrumentation requiring screws or distraction, intracranial/spinal/vascular procedures, high‑risk thyroid/parathyroid surgery with risk to the recurrent laryngeal nerve, and selected head and neck or cranial nerve surgeries). The policy specifies real‑time monitoring with continuous communication to the surgical team as a requirement for medical necessity and identifies uses considered not medically necessary or investigational when criteria are not met.

Evidence type	Summary
Randomized controlled trial (thyroid surgery)	RCT of 1000 patients showed significant reduction in recurrent laryngeal nerve injury in high-risk thyroid surgery patients
Systematic reviews (anterior cervical spine)	Four systematic reviews of case series/cohort studies; most found no statistically significant difference for RLN injury with IONM vs no IONM
Systematic reviews/meta-analyses (spinal instrumentation)	Evidence suggests high sensitivity and specificity for detecting neurologic deficits; sufficient to improve net health outcome

Medicare Determinations

Number	Name	Effective Date/Type
160.8	Electroencephalographic Monitoring During Surgical Procedures Involving the Cerebral Vasculature
L34623	Intraoperative Neurophysiological Testing	2018-10-01 / LCD

Revision History

11/1/2024revisedLatest

Motor evoked potentials expanded to include additional medically necessary indications. Policy revised effective 11/1/2024 to expand MEP indications.

6/2023addedLatest

New indication for spinal instrumentation requiring screws or distraction added; considered covered within existing medically necessary policy for spinal procedures.

2/2024clarified

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyIntraoperative Neurophysiologic Monitoring and Evoked Potential Testing

Policy CodePolicy 211

Change TypeRevised (MEP expansion) / Added (spinal instrumentation) / Clarified (billing)

Effective Date

Next Review Date

Key ActionSubmit prior authorization requests via Authorization Manager and document qualifying ICD-10 diagnoses and any high-risk features when requesting IONM.

On This Page

Facial Nerve

Head and/or neck procedures (e.g., acoustic neuroma, microvascular decompression of the facial nerve for hemifacial spasm, parotid tumor resection, cochlear implantation, middle ear, and mastoid surgery and other neurotologic/otologic surgical procedures).

Recurrent Laryngeal Nerve

High-risk thyroid or parathyroid surgery, including total thyroidectomy or hemithyroidectomy, repeat thyroid or parathyroid surgery, surgery for cancer, thyrotoxicosis, retrosternal or giant goiter, thyroiditis.
Anterior cervical spine surgery associated with increased risk situations when monitoring of the laryngeal nerve is necessary (prior anterior cervical surgery/revision, multilevel anterior cervical discectomy and fusion, preexisting recurrent laryngeal nerve pathology with residual function).

Other Nerves / Procedures

High risk vascular procedures with risk for cerebral ischemia (e.g., aortic arch, thoracic aorta, internal carotid endarterectomy, intracranial AVM, bronchial artery AVM/tumor, cerebral aneurysm).
Brachial or lumbar plexus surgery.
Spinal procedures with high risk of cord injury (e.g., spinal cord tumor, spinal fracture with cord compression, mechanical spinal distraction, correction of scoliosis).
Other procedures with high risk of potential injury to essential nervous system structures (e.g., interventional neuroradiology, peripheral nerve neuroma surgery, leg lengthening with traction on sciatic nerve).

IONM - Not Medically Necessary / Investigational

IONM is considered NOT MEDICALLY NECESSARY or INVESTIGATIONAL in the following situations:

ANY of the following

Intraoperative neurophysiologic monitoring for surgery of the cervical spine not meeting the above criteria (e.g., standard anterior cervical discectomy and fusion, cervical disc arthroplasty) is NOT MEDICALLY NECESSARY.
IONM is NOT MEDICALLY NECESSARY for ANY other indication not specified as medically necessary, including monitoring of epidural injections, monitoring during radiofrequency ablation/denervation procedures, and monitoring during placement of spinal cord stimulator or intrathecal pain pump.
IONM is considered INVESTIGATIONAL when the above criteria are not met.
IONM of the recurrent laryngeal nerve during anterior cervical spine surgery not meeting the criteria above or during esophageal surgeries is considered INVESTIGATIONAL.
Intraoperative monitoring of visual-evoked potentials is considered INVESTIGATIONAL.
Intraoperative motor-evoked potentials using transcranial magnetic stimulation are INVESTIGATIONAL due to lack of FDA approval.
Intraoperative electromyography and nerve conduction velocity monitoring during surgery on the peripheral nerves are INVESTIGATIONAL.

Visual Evoked Potential (VEP) Testing - Medically Necessary

VEPs may be considered MEDICALLY NECESSARY for diagnosis, evaluation, or monitoring when ANY of the following conditions are present:

ANY of the following

Multiple sclerosis or neuromyelitis optica (NMO), or other demyelinating disorders of the optic nerve.
Suspected disorder of the optic nerve, optic chiasm or optic radiations not explained by MRI, CT, infectious diseases or metabolic disorders.

VEP Testing - Not Medically Necessary

VEPs are considered NOT MEDICALLY NECESSARY for all other uses, including routine screening of infants.

Somatosensory Evoked Potential (SSEP) Testing - Medically Necessary

SSEPs may be considered MEDICALLY NECESSARY when the results will be used to guide clinical management for ANY of the following:

ANY of the following

Acute (within 72 hrs. of onset) anoxic encephalopathy.
Coma following traumatic, hypoxic-ischemic and other diffuse brain injuries.
CNS deficiency identified on clinical exam when not explained by appropriate imaging studies.
Demyelinating disease (e.g., multiple sclerosis) when diagnosis is uncertain and clinical suspicion exists based on neurologic symptoms or CSF evaluation.
Unexplained myelopathy.
Spinocerebral degeneration (e.g., Friedreich's ataxia).
Spinal cord lesions secondary to trauma when the need for surgical intervention is uncertain.
Suspected brain death.

SSEP Testing - Not Medically Necessary

SSEPs are considered NOT MEDICALLY NECESSARY for all other uses.

Motor Evoked Potential (MEP) Testing - Medically Necessary

Motor evoked potentials may be considered MEDICALLY NECESSARY when the results will be used to guide clinical management for ANY of the following:

ANY of the following

Acute (within 72 hrs. of onset) anoxic encephalopathy.
Coma following traumatic, hypoxic-ischemic and other diffuse brain injuries.
CNS deficiency identified on clinical exam when not explained by appropriate imaging studies.
Demyelinating disease (e.g., multiple sclerosis) when diagnosis is uncertain and clinical suspicion exists based on neurologic symptoms or CSF evaluation.
Unexplained myelopathy.
Spinocerebral degeneration (e.g., Friedreich's ataxia).
Spinal cord lesions secondary to trauma when the need for surgical intervention is uncertain.
Suspected brain death.
Evaluation of suspected hysterical or factitious paralysis (MEPs considered medically necessary).

MEP Testing - Not Medically Necessary

Motor evoked potentials are NOT MEDICALLY NECESSARY in the non-operative setting when the above criteria are not met; and are NOT MEDICALLY NECESSARY for all other uses.

Medical necessity criteria for listed ICD-10 diagnoses

The above medical necessity criteria MUST be met for the following codes to be covered for Commercial Members: Managed Care (HMO and POS), PPO, Indemnity, Medicare HMO Blue and Medicare PPO Blue:

Member has one of the specified ICD-10 diagnosis codes (see code_groups ICD-10 list).

Coverage of CPT codes for VEP

Coverage decision for VEP testing

CPT 95930 (Visual evoked potential (VEP) checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report) is covered when the required medical necessity criteria (specified ICD-10 diagnoses) are met.

Investigational / Not covered

Codes considered investigational for the specified member types

HCPCS/CPT 0464T (Visual evoked potential, testing for glaucoma, with interpretation and report) is considered investigational for Commercial Members and Medicare HMO Blue and Medicare PPO Blue.

Medically Necessary Indications (summarized from evidence)

Covered when the procedure places neural structures at risk and evidence or clinical input supports benefit in the specific setting:

ANY of the following

Spinal instrumentation requiring screws or distraction (evidence sufficient to improve net health outcome).
Thyroid or parathyroid surgery in patients at high risk for recurrent laryngeal nerve injury (high-risk defined in trial as cancer, thyrotoxicosis, retrosternal or giant goiter, thyroiditis; may include prior thyroid/parathyroid surgery or total thyroidectomy; low surgical volume may increase risk).
Intracranial, spinal, or vascular procedures (broad acceptance; standard of care in many settings per society guidelines).

Medically Necessary with Clinical Input (anterior cervical spine surgery)

Clinical expert opinion supports use in a subgroup of appropriately selected patients:

ALL of the following

ONE of
- Prior anterior cervical surgery (e.g., revision ACDF, reoperation through scarred field, reoperation for pseudarthrosis, revision for failed fusion).
- Multilevel anterior cervical discectomy and fusion.
- Preexisting recurrent laryngeal nerve pathology with residual function.

Insufficient Evidence / Investigational Indications

Not established as improving net health outcome or evidence insufficient:

ANY of the following

Esophageal surgery (systematic review of mainly nonrandomized studies; less recurrent laryngeal nerve palsy reported but evidence not robust).
Surgery proximal to peripheral nerves (case series/cohort studies; no prospective comparative studies demonstrating improved outcomes).
Monitoring of peripheral nerves for many non-instrumentation settings where prospective comparative outcome data lacking.

Documentation Required

Authorization Manager Submission Requirements

Providers must use Authorization Manager to submit initial authorization requests and must enter the facility's NPI/provider ID where services are performed and the appropriate surgeon's NPI/provider ID as the servicing provider.

Facility NPI or provider ID (where services performed)
Servicing surgeon NPI or provider ID

Billing Rule

EMG coding with IONM

When EMG is utilized as part of IONM, the appropriate EMG CPT code (policy #701) must be utilized in conjunction with 95940, 95941 or G0453. If EMG is being used for intraoperative monitoring, both the EMG CPT code and the intraoperative monitoring code should be reported (clarified 2/2024).

Affected codes: 95940, 95941, G0453
See policy #701 for appropriate EMG CPT codes
Reference: Policy #211 coding clarification (2/2024)

Documentation Required

Document qualifying ICD-10 diagnosis

To bill CPT 95930 for covered members, the medical record/claim must be associated with one of the specified ICD-10 diagnosis codes listed in the policy.

See ICD-10 list in policy
95930 + ICD-10 list

Denial Risk

Investigational code denial risk

Claims submitted with CPT 0464T (VEP for glaucoma) may be considered investigational and subject to denial for Commercial and specified Medicare members.

0464T - VEP for glaucoma

Prior Authorization

Prior authorization requirement (historical)

Prior authorization is required for HMO Commercial Managed Care (HMO and POS) and Commercial PPO as noted in policy history; providers should submit PA requests per plan procedures (Authorization Manager referenced in 9/2023).

Billing Rule

Report services & document selection criteria

Providers should report all services using the most up-to-date procedure, revenue, and diagnosis codes, including modifiers where applicable; when requesting IONM for thyroid/parathyroid or anterior cervical spine surgery, document the presence of high-risk features or the specific clinical selection criteria.

Use current procedure/revenue/diagnosis codes and include modifiers where applicable
Document high-risk features or selection criteria when requesting IONM for thyroid/parathyroid or anterior cervical spine surgery

Documentation Required

Document high-risk features for thyroid/parathyroid and selection criteria for anterior cervical surgery

Prior anterior cervical surgery (e.g., revision ACDF, reoperation through scarred field, reoperation for pseudarthrosis, revision for failed fusion)
Multilevel anterior cervical discectomy and fusion (multilevel ACDF)
Preexisting recurrent laryngeal nerve pathology with residual function

Coding clarification that both EMG CPT code and intraoperative monitoring code are needed if EMG used for IONM (added cross-reference to related policy #701).

6/2026annual_review

Annual policy review with literature updates; policy statements unchanged. Policy updated with literature review through March 9, 2026.