CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP032

Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy

This policy governs coding, documentation, billing, and reimbursement requirements for intraoperative neurophysiologic monitoring (IONM) services rendered to members under Blue Cross and Blue Shield of Oklahoma plans and affects providers who bill for IONM.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyIntraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy

Policy CodePolicy CPCP032

Change TypeNo material change

Effective DateOct 3, 2024

Next Review Date

Key ActionSubmit event/chat log and requested supporting records upon request to support reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

CPCP032policy identifier

2024-10-03plan effective date

2024-09-24committee approval

G0453/95940/95941primary timed codes

MED205.011related policy

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Separately Reimbursable IONM Service Criteria

Separately reimbursable IONM service criteria

Covered when ALL of the following criteria are met:

ALL of the following

Interpreting physician must be a licensed physician separate from the surgical team
Physician must be separate from operating surgeon, assistant surgeons, and/or anesthesiologists.
Attendance
- Interpreting physician is physically in attendance in the operating suite
- ALL of the following
  - Interpreting physician is constantly available to interpret the recording and advise the surgeon
  - There is live video (screen sharing) of the monitoring identical to the technician’s display and a high-quality bi-directional live audio connection allowing conversation with the operating surgeon
    Cell phone or cellular walkie‑talkie is not considered adequate; review of recordings post‑operatively does not constitute live monitoring.
ALL of the following
- Event/chat log shows the operating surgeon ordered IONM by a licensed physician separate from the surgical team
- Audio/video connection type is documented (e.g., VoIP or screen monitoring) and noted as established
- Monitoring physician completed a baseline review verbally with the surgeon and communicated any events and a closing review verbally
- Documentation includes start and stop times, what was communicated, who communicated it, and how it was communicated
- Documentation lists the name of the technologist and their credentials
- Documentation indicates the professional component of monitoring and test interpretation (append modifier -26 for professional component)
Technician services and monitoring equipment are not separately reimbursable from the monitoring physician’s reimbursement
Facility may negotiate technician/equipment costs directly with the facility; technical component is facility responsibility.

Timed IONM Monitoring Codes and Unit Rules

Timed IONM monitoring codesCPT | HCPCS | mixedCovered

95940	CPT add-on code for intraoperative neurophysiology monitoring — one-on-one in operating room, billed per 15-minute unit (not billable for 7 minutes or less)
95941	CPT add-on code for intraoperative neurophysiology monitoring — remote/nearby monitoring, billed per hour unit (not billable for 30 minutes or less)
G0453	HCPCS code for undivided attention by a monitoring provider to a single member, billed in 15-minute units (not billable for 7 minutes or less)

Minimum time per unit — CPT 95940/95941 and HCPCS G0453

95940 (CPT add-on)Billed per 15-minute unit when monitoring is performed in a one-on-one setting inside the operating room; not billable for 7 minutes or less; units reflect total one-on-one monitoring time even if discontinuous.

95941 (CPT add-on)Billed per hour unit for remote or nearby monitoring for one or more overlapping operative sessions; not billable for 30 minutes or less; units reflect total monitoring duration even if discontinuous.

G0453 (HCPCS)Billed in 15-minute units for undivided attention by a monitoring provider to a single member; not billable for 7 minutes or less; multiple units may be non-contiguous but must reflect cumulative one-on-one monitoring time.

Unit midpoint rule (examples)A unit is attained when the mid-point has passed (e.g., 37 minutes = 2 units of G0453; 2 hours 30 minutes = 2 units of 95941; a 3rd unit requires reaching 38 minutes or 2 hours 31 minutes respectively).

Documentation and Submission Requirements

Documentation Required

Documentation upon request

The plan may request supporting documentation to substantiate medical necessity and appropriate coding/billing. Submit the event/chat log and any requested records to support reimbursement. Failure to provide requested documentation may affect claims processing and reimbursement.

Event/chat log documentation of monitoring, including details of communications and actions during the case
Evidence that the operating surgeon (ordering physician) requested IONM services by a licensed physician separate from the surgical team
Description of the audio and video (screen sharing) connection used (for example, VOiP or screen monitoring). See Separately Reimbursable Services for IONM — Billing Requirements for additional detail
Confirmation that the monitoring physician completed a baseline review verbally with the surgeon using the audio connection
Documentation that the monitoring physician communicated any intraoperative events to the surgeon verbally using the audio connection
Record that the monitoring physician completed a closing review verbally with the surgeon
Documentation of the professional component of monitoring and test interpretation
Start and stop times for the services provided
Details of what was communicated during the service, who communicated it, and how it was communicated
Name of the technologist and their credentials

Key Definitions

Intraoperative neurophysiologic monitoring (IONM)

DefinitionIntraoperative neurophysiologic monitoring (IONM) describes procedures used to monitor integrity of neural pathways during high-risk neurosurgical, orthopedic, and vascular surgeries to identify nervous system impairment and help prevent permanent deficits.

PurposeDetects electrical signals produced by the nervous system in response to sensory or electrical stimuli to inform on functional integrity of neuronal structures.

Modalities includedIncludes SSEP, MEP (transcranial electrical stimulation), BAEP, EMG, EEG, and ECoG among others.

Evoked potentials (EP)

Evoked potentials (EP)Responses (electrical signals) produced by the nervous system in response to a stimulus used to help diagnose nerve disorders, localize nerve damage, and evaluate condition during or after treatment or surgery.

Role in IONMEP modalities (e.g., SSEP, BAEP) provide real‑time information about pathway integrity during operative procedures.

Clinical useHelp determine location of nerve injury and assess member status intraoperatively to guide interventions intended to prevent permanent deficits.