OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentProvidence Health PlanPolicy 295

Intraoperative Monitoring

Customize your policy alerts

Sign up for Providence Health Plan Policy 295 alerts

Get alerted when Policy 295 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy governs coverage and medical-necessity criteria for continuous intraoperative neurophysiological monitoring, including eligible spine and non-spine procedures, for applicable Providence commercial and Medicaid/OHP members. It also establishes documentation, provider, hospital-setting, technical, and billing requirements.

Policy Summary

PayerProvidence Health Plan

PolicyIntraoperative Monitoring

Policy CodePolicy 295

Change TypeNo material change

Effective DateOct 1, 2026

Last ReviewSep 1, 2026

Next Review DateSep 1, 2027

Key ActionThe operating surgeon must submit the prior authorization request for monitoring and establish the applicable medical-necessity indication.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Monitoring codes addressed

4Spine indication categories

7Non-spine indication categories

8Minimum recording channels

16EEG recording channels

Hospital onlyRequired setting

Medical Necessity and Coverage Criteria

Spine indications

Continuous intraoperative neurophysiological monitoring may be considered medically necessary when there is significant risk of nerve or spinal cord injury and at least one of the following spine indications is present.

Qualifying spine indication

Repeat spinal surgery with instrumentation.
Spinal stenosis with myelopathy: Surgery for significant spinal stenosis with myelopathy.Significant spinal stenosis with myelopathy
See the policy definition of myelopathy.
Correction of significant spinal deformity: Surgical instrumentation for correction of scoliosis or significant congenital, traumatic, or degenerative spinal deformity.

Policy Summary

PayerProvidence Health Plan

PolicyIntraoperative Monitoring

Policy CodePolicy 295

Change TypeNo material change

Effective DateOct 1, 2026

Last ReviewSep 1, 2026

Next Review DateSep 1, 2027

Key ActionThe operating surgeon must submit the prior authorization request for monitoring and establish the applicable medical-necessity indication.

SourceLink

On This Page

High-risk cervical spine surgery, such as surgery for a vertebral or intraspinal tumor, traumatic spine or spinal cord injury including subluxation or dislocation, deformity correction, or surgery of the spinal cord.

Non-spine indications

Continuous intraoperative neurophysiological monitoring may be considered medically necessary when at least one of the following non-spine indications is present.

Qualifying non-spine indication

Cranial nerve monitoring: Monitoring of a cranial nerve during head or neck surgery, such as skull-base tumor resection, tumor involving a cranial nerve, cavernous sinus tumor, neck dissection, or epileptogenic brain tumor or tissue resection.
High-risk thyroid surgery: Monitoring of recurrent laryngeal nerve function during high-risk thyroid surgery, such as complete resection of a thyroid lobe, removal of the entire gland, surgery for malignancy, or repeat thyroid or parathyroid surgery.
Facial nerve monitoring: Monitoring of facial nerve function during surgery, such as acoustic neuroma surgery, microvascular decompression for hemifacial spasm, parotid tumor resection, or neurotologic or otologic procedures.
High-risk vascular surgery, such as surgery of the aortic arch or thoracic aorta, internal carotid endarterectomy, cerebral aneurysm surgery, intracranial or spinal arteriovenous malformation surgery, or distal aortic procedures with risk of spinal cord ischemia.
Essential peripheral nervous system structure risk: The planned surgery poses a high risk of significant damage to an essential nervous system structure, such as surgery for a peripheral nerve neuroma or leg lengthening with traction on the sciatic nerve.High risk of significant damage
Essential brain function risk: The planned surgery poses a high risk of significant damage to essential brain function, such as surgery for intractable or basal ganglia movement disorders or resection of brain tissue close to the primary motor cortex requiring brain mapping.High risk of significant damage
Brachial plexus surgery.

Not medically necessary services

The following services are considered not medically necessary.

Not medically necessary monitoring

Spine criteria not met: Spine monitoring when the qualifying spine criteria are not met, including initial spine surgery, routine decompression or laminotomy, nonqualifying cervical surgery, nonqualifying lumbar surgery below L1/L2, radiofrequency ablation, epidural steroid injections, facet joint injections, and spinal cord stimulator placement.
Non-spine criteria not met: Non-spine monitoring when the qualifying non-spine criteria are not met.
Visual evoked potentials: Continuous intraoperative monitoring of visual evoked potentials.

Diagnostic use in selected high-risk surgery

IONM may have diagnostic utility when used under appropriate professional supervision in selected surgeries that place neural structures at risk.

Selected high-risk procedures: The operating surgeon believes monitoring is warranted for diagnostic value, including deformity correction, spinal instability, spinal cord compression, intradural spinal cord lesions, procedures near peripheral nerves or nerve roots, complex, extensive, or lengthy spine surgery, or surgery risking injury to the brain, brainstem, spinal cord, or facial nerve.

Examples are not necessarily exhaustive.

Qualified supervision: When IONM is used with SSEPs or MEPs, it is conducted under the supervision of a clinical neurophysiologist experienced with IONM.

Evidence was insufficient to evaluate monitoring conducted by technicians alone or by an automated device.

Not medically necessary or unsupported therapeutic use

The policy identifies circumstances in which monitoring is not medically necessary or has no established therapeutic benefit.

Non-covered or non-medically-necessary circumstances: Monitoring is performed during lumbar surgery below spinal column level L1-L2 or during cervical spine surgery when billed with CPT 95940 or HCPCS G0453; monitoring is used solely as a therapeutic adjunct to improve neurological outcome; or multimodality monitoring is used during intramedullary tumor resection for therapeutic benefit.Lumbar surgery below L1-L2 or cervical spine surgery

The policy states that 95940 and G0453 deny as not medically necessary in the specified lumbar and cervical surgery circumstances. Evidence does not establish improved neurological outcome from use solely as a therapeutic adjunct, including during intramedullary tumor resection.

Prior Authorization Required

Prior authorization is required when the service is billed with any diagnosis code in the policy's prior-authorization diagnosis table.

Prior authorization requirement: Intraoperative neurophysiological testing and monitoring billed with CPT 95940 or HCPCS G0453 requires prior authorization when billed with any diagnosis code listed in the prior-authorization table.Any listed diagnosis code

The diagnosis list includes the codes in the policy appendix, spanning the listed diagnosis-code table.

Medically Necessary Without Prior Authorization

The service may be considered medically necessary and covered without prior authorization only when billed with any diagnosis code in the listed diagnosis-code table.

Covered without prior authorization: Intraoperative neurophysiological testing and monitoring billed with CPT 95940 or HCPCS G0453 may be considered medically necessary and covered without prior authorization when billed with any diagnosis code listed in the medically-necessary-without-prior-authorization table.Any listed diagnosis code

This pathway applies only to the diagnosis codes listed in the policy table.

Not Medically Necessary

The service is not medically necessary and is not covered for the listed diagnoses in the specified surgical contexts.

Not medically necessary: Intraoperative neurophysiological testing and monitoring billed with CPT 95940 or HCPCS G0453 will deny as not medically necessary and not covered when billed with any listed diagnosis code for lumbar surgery below L1 and L2 or cervical surgery.Lumbar surgery below L1 and L2 or cervical surgery; any listed diagnosis code

The listed diagnosis codes are M43.26, M43.27, M43.28, M43.5X6, M43.5X7, M43.5X8, M45.6, M45.7, M45.8, M46.26, M46.27, M46.28, C41.4, D16.8, and G83.4.

Specified lumbar and cervical surgery diagnosis combinations

Intraoperative neurophysiological testing and monitoring is not medically necessary and not covered when billed with the listed diagnoses in the specified surgical settings.

Not medically necessary: The service is CPT 95940 or HCPCS G0453; the claim is for lumbar surgery below L1 and L2 or cervical surgery; and the claim includes one or more diagnosis codes listed in the policy's specified diagnosis and surgery combination tables.Lumbar surgery below L1 and L2 or cervical surgery; one or more listed diagnosis codes

The policy states that claims with these diagnosis and surgical-context combinations will deny as not medically necessary and not covered. The listed combinations include lumbar and spinal injury, cervical injury, neurologic, musculoskeletal, congenital, and related diagnosis codes shown in the policy tables.

Spine monitoring is not medically necessary when the applicable qualifying spine criteria are not met. This includes initial or routine spine surgery, routine decompression or laminotomy, non-high-risk cervical surgery, and lumbar surgery below L1/L2 without qualifying risk factors. Radiofrequency ablation, epidural steroid injections, facet joint injections, and spinal cord stimulator placement are also excluded.

Continuous intraoperative monitoring of visual evoked potentials (VEP) is considered not medically necessary.

CPT 95940 and HCPCS G0453 will deny as not medically necessary when performed during lumbar surgery below spinal column level L1-L2 and/or during cervical spine surgery.

Intraoperative monitoring is not recommended solely as a therapeutic adjunct. Evidence is insufficient to establish that monitoring improves neurological outcomes, including when intraoperative alerts occur.

CPT 95940 and HCPCS G0453 are not covered when billed with the listed diagnosis codes for lumbar surgery below L1 and L2 or for cervical surgery. The listed codes include M43.26, M43.27, M43.28, M43.5X6, M43.5X7, M43.5X8, M45.6, M45.7, M45.8, M46.26, M46.27, M46.28, C41.4, D16.8, and G83.4.

Intraoperative neurophysiological testing and monitoring billed with CPT 95940 or HCPCS G0453 is expressly excluded when the claim combines a listed diagnosis code with lumbar surgery below L1 and L2 or cervical surgery. Such claims deny as not medically necessary and not covered.

Continuous intraoperative neurophysiological monitoring is considered not medically necessary when the applicable qualifying spine or non-spine criteria are not met. Continuous intraoperative VEP monitoring is also not medically necessary.

CPT 95940 and HCPCS G0453 will deny as not medically necessary when performed during lumbar surgery below spinal column level L1-L2 and/or during cervical spine surgery.

There is no demonstrated therapeutic benefit from multimodality monitoring during intramedullary tumor resection for improving gross total tumor resection or neurological outcome. Monitoring is therefore not supported when used for that therapeutic purpose.

Claims for CPT 95940 or HCPCS G0453 deny as not medically necessary and not covered when billed with M43.26, M43.27, M43.28, M43.5X6, M43.5X7, M43.5X8, M45.6, M45.7, M45.8, M46.26, M46.27, M46.28, C41.4, D16.8, or G83.4 for lumbar surgery below L1 and L2 or cervical surgery.

The listed diagnosis and surgery combinations are expressly classified as not medically necessary and not covered. Claims for CPT 95940 or HCPCS G0453 deny when a listed diagnosis is paired with lumbar surgery below L1 and L2 or cervical surgery.

Coding, Technical Requirements, and Diagnosis Tables

Continuous Intraoperative Neurophysiological MonitoringCPTCovered

95940

Continuous intraoperative neurophysiology monitoring in the operating room, one-on-one monitoring requiring personal attendance, each 15 minutes.

Continuous Intraoperative Neurophysiological MonitoringHCPCSCovered

G0453

Continuous intraoperative neurophysiological monitoring from outside the operating room, per patient, each 15 minutes.

Not CoveredCPTNot Covered

95941

Intraoperative neurophysiology code; not covered per Coding Policy 89.

Intraoperative Neurophysiological Testing and MonitoringmixedCovered

95940	Continuous intraoperative neurophysiology monitoring in the operating room, one-on-one monitoring requiring personal attendance, each 15 minutes.
G0453	Continuous intraoperative neurophysiological monitoring from outside the operating room, per patient, each 15 minutes.

Neuromuscular Junction TestingCPTNot Covered

95937

Neuromuscular junction testing; same as Train of Four testing, routine anesthesia care and not separately billable.

Electroencephalogram (EEG)CPT

95707	Electroencephalogram (EEG).
95717	EEG professional review and interpretation of recorded events, 2–12 hours, without video.
95812	EEG extended monitoring; 41–60 minutes.
95813	EEG extended monitoring; 61–119 minutes.
95822	EEG recording in coma or sleep only.
95955	EEG during nonintracranial surgery, such as carotid surgery.
95957	Digital analysis of EEG.

Somatosensory Evoked Potential (SSEP)CPT

95925	Short-latency SSEP study; upper limbs.
95926	Short-latency SSEP study; lower limbs.
95927	Short-latency SSEP study; trunk or head.
95938	Short-latency SSEP study; upper and lower limbs.

Motor Evoked Potential (MEP)CPT

95928	Central motor evoked potential study; upper limbs.
95929	Central motor evoked potential study; lower limbs.
95939	Central motor evoked potential study; upper and lower limbs.

Auditory Brainstem Evoked Potential / Brainstem Auditory Evoked PotentialCPT

92652	Auditory evoked potentials for threshold estimation at multiple frequencies, with interpretation and report.
92653	Auditory evoked potentials; neurodiagnostic, with interpretation and report.

Peripheral Nerve StimulationCPT

95885	Needle electromyography, each extremity, complete, performed with nerve conduction study.
95886	Needle electromyography, each extremity, limited, performed with nerve conduction study.
95887	Needle electromyography, non-extremity muscle(s), performed with nerve conduction study.

Nerve Conduction StudiesCPT

95907	Nerve conduction studies; 1–2 studies.
95908	Nerve conduction studies; 3–4 studies.
95909	Nerve conduction studies; 5–6 studies.
95910	Nerve conduction studies; 7–8 studies.
95911	Nerve conduction studies; 9–10 studies.
95912	Nerve conduction studies; 11–12 studies.
95913	Nerve conduction studies; 13 or more studies.

Oculomotor, Facial, Trigeminal and Lower Cranial Nerve MonitoringCPT

95867	Needle EMG; cranial nerve supplied muscle(s), unilateral.
95868	Needle EMG; cranial nerve supplied muscles, bilateral.
95933	Orbicularis oculi (blink) reflex by electrodiagnostic testing.

Free-Running Electromyography (EMG)CPT

51785	Needle EMG studies of anal or urethral sphincter.
95860	Needle EMG; one extremity.
95861	Needle EMG; two extremities.
95863	Needle EMG; three extremities.
95864	Needle EMG; four extremities.
95870	Needle EMG; limited study of muscles in one extremity or non-limb axial muscles.

Prior Authorization Required — Procedure Codesmixed

95940	Intraoperative neurophysiological testing and monitoring.
G0453	Remote intraoperative neurophysiological monitoring.

Prior Authorization Required — Diagnosis CodesICD-10

G54.1	Lumbosacral plexus disorders.
M40.03	Spinal deformity diagnosis code.
M41.02	Scoliosis diagnosis code.
M47.012	Cervical spondylosis diagnosis code.
M48.02	Cervical spinal stenosis diagnosis code.
S12.090A	Cervical vertebral fracture, initial encounter.
S22.042A	Thoracic vertebral fracture, initial encounter.
S32.020A	Lumbar vertebral fracture, initial encounter.

Medically Necessary Without Prior AuthorizationICD-10Covered

A18.01	Tuberculosis of spine.
C41.2	Malignant neoplasm of vertebral column.
C70.0	Malignant neoplasm of cerebral meninges.
G95.0	Syringomyelia and syringobulbia.
I60.00	Nontraumatic subarachnoid hemorrhage.
M47.021	Other spondylosis with myelopathy, cervical region.

Not Medically NecessaryICD-10Not Covered

M43.26	Fusion of lumbar spine region.
M43.27	Fusion of lumbosacral region.
M43.28	Fusion of sacral and sacrococcygeal region.
M43.5X6	Other deformity of lumbar region.
M45.6	Ankylosing spondylitis, thoracolumbar region.
M46.26	Osteomyelitis of vertebra, lumbar region.
C41.4	Malignant neoplasm of bones of pelvis, sacrum and coccyx.
D16.8	Benign neoplasm of other specified bones.
G83.4	Cauda equina syndrome.

Intraoperative Neurophysiological Testing and Monitoring — NoncoveredmixedNot Covered

95940	Denied as not medically necessary when applicable diagnosis codes are billed for lumbar surgery below L1–L2 or cervical surgery.
G0453	Denied as not medically necessary when applicable diagnosis codes are billed for lumbar surgery below L1–L2 or cervical surgery.

Diagnosis Codes Associated With Not Medically Necessary Intraoperative MonitoringICD-10Not Covered

M53.3	Sacrococcygeal disorders.
M54.40	Lumbago with sciatica, unspecified side.
M99.23	Osseous and subluxation stenosis of intervertebral foramina of lumbar region.
Q76.426	Congenital musculoskeletal deformity.
S32.000A	Fracture of unspecified lumbar vertebra, initial encounter.
S32.009D	Unspecified fracture of unspecified lumbar vertebra, subsequent encounter.
S32.019D	Fracture of first lumbar vertebra, subsequent encounter.
S32.049D	Fracture of fourth lumbar vertebra, subsequent encounter for routine healing.
S32.129S	Fracture of sacrum, sequela.

Spinal Injury Diagnosis CodesICD-10Not Covered

S12.000D	Cervical vertebra fracture, subsequent encounter.
S13.0XXD	Cervical disc disorder, subsequent encounter.
S22.009D	Thoracic vertebra fracture, subsequent encounter.
S32.049D	Fracture of fourth lumbar vertebra, subsequent encounter for routine healing.
S33.100D	Dislocation of lumbar vertebra, subsequent encounter.
S34.102D	Injury of lumbar spinal cord, subsequent encounter.

Neurologic and Nervous-System-Related Diagnosis CodesICD-10Not Covered

G95.89	Other specified diseases of spinal cord.
G96.00	Cerebrospinal fluid leak, unspecified.
G97.41	Accidental puncture or laceration of dura during a procedure.
G97.61	Postprocedural hemorrhage and hematoma of nervous system organ or structure.

Musculoskeletal and Spine Diagnosis CodesICD-10Not Covered

M42.01	Juvenile osteochondrosis of spine, cervical region.
M43.3	Recurrent dislocation, vertebrae.
M47.21	Other spondylosis with radiculopathy, cervical region.
M48.01	Spinal stenosis, occipito-atlanto-axial region.
M50.00	Cervical disc disorder with myelopathy.
M54.2	Cervicalgia.

Congenital Musculoskeletal Diagnosis CodesICD-10Not Covered

Q76.411	Congenital scoliosis, occipito-atlanto-axial region.
Q76.412	Congenital scoliosis, cervical region.
Q76.49	Other congenital musculoskeletal deformities of spine and chest.

Cervical Spine Injury Diagnosis CodesICD-10Not Covered

S12.000D	Fracture of unspecified cervical vertebra, subsequent encounter.
S12.090D	Other displaced fracture of first cervical vertebra, subsequent encounter.
S12.490D	Other displaced fracture of fifth cervical vertebra, subsequent encounter.
S13.0XXD	Traumatic rupture of cervical intervertebral disc, subsequent encounter.
S14.119D	Injury of unspecified cervical spinal cord, subsequent encounter.

Device Complication and Follow-up Diagnosis CodesICD-10Not Covered

T84.216D	Breakdown of internal fixation device of vertebrae, subsequent encounter.
T84.226D	Displacement of internal fixation device of vertebrae, subsequent encounter.
T84.296D	Other mechanical complication of internal fixation device of vertebrae, subsequent encounter.
Z47.2	Encounter for removal of internal fixation device.
Z48.811	Encounter for surgical aftercare following surgery on specified body system.

Minimum Recording Channels

Minimum recording channelsAt least 8 recording channels must be available for all intraoperative neurophysiological monitoring; 16 channels are required when EEG is monitored.

Simultaneous Monitoring Cases

Simultaneous monitoring casesA physician may monitor up to 3 cases simultaneously for other medically necessary monitoring; when undivided attention is required, the physician must bill only that one case and have a plan to transfer care for other cases.

Remote IONM Billing Interval

Remote IONM billing intervalG0453 represents professional services per 15 minutes of focused attention on one patient. At least 8 minutes of care are required to bill a 15-minute interval; total time is the sum of focused time.

Lumbar Surgery Anatomical Level

Lumbar surgery anatomical levelLumbar surgery performed below spinal column level L1–L2 is subject to the policy's not-medically-necessary rule when the applicable spine criteria are not met.

Authorization, Documentation, and Billing Requirements

Prior Authorization

Operating Surgeon Must Request Authorization

The operating surgeon must request intraoperative monitoring in the prior authorization submission for reimbursement.

Prior Authorization

Diagnosis-Dependent Prior Authorization

Prior authorization may be required for intraoperative neurophysiological testing and monitoring when CPT 95940 or HCPCS G0453 is billed, depending on the diagnosis codes submitted.

CPT 95940
HCPCS G0453

Prior Authorization

Authorization Required for Listed Diagnoses

Prior authorization is required when CPT 95940 or HCPCS G0453 is billed with any diagnosis code identified in the policy’s Prior Authorization Required list. Providers should verify the complete diagnosis-code list in the applicable policy appendix before submitting the request.

Use the complete diagnosis-code authorization pathway in the policy appendix.
Authorization requirements apply to the listed diagnosis codes.

Unsupported block type: documentation

Unsupported block type: prior_auth

Documentation Required

Technician Attendance and Communication

A specifically trained technician, preferably registered with a credentialing organization, must be in continuous attendance in the operating room. The technician must record and monitor a single surgical case and have physical or electronic capacity for real-time communication with the supervising neurologist or other qualified physician.

Continuous operating-room attendance.
One surgical case at a time.
Real-time communication with the supervising physician.

Note

Remote Monitoring Capabilities

Remote monitoring is permitted only when the trained technician is continuously present in the operating room and the supervising physician can view baseline testing and monitoring tracings as they are obtained in real time.

Real-time viewing of tracings in the operating room.
Access to baseline electrophysiological testing and earlier case tracings.

Note

Technical Equipment Requirements

Mandatory technical capabilities include at least eight recording channels for intraoperative neurophysiological monitoring, or 16 channels when EEG is monitored. Equipment must support all modalities that may be applied, including auditory-evoked responses, EEG/electrocorticography, EMG and nerve conduction, and somatosensory-evoked responses.

At least 8 recording channels.
At least 16 channels when EEG is monitored.
Support all applicable monitoring modalities.

Note

Anesthesia Communication

When medically indicated, maintain continuous communication between the anesthesiologist and the monitoring physician because anesthesia can significantly affect interpretation of intraoperative studies. Remote monitoring must also support routine real-time auditory or written communication and telephone communication as needed.

Communication with the anesthesiologist when medically indicated.
Telephone capability among the supervising physician, monitoring technologist, operating surgeon and anesthesiologist.

Billing Rule

Concurrent Case Monitoring

When a case requires undivided attention, the monitoring physician must have a plan to transfer care for another case. During periods of exclusive attention, the physician may code and bill only the single case; otherwise, physician billing is limited to time devoted to monitoring when attention is directed exclusively to one patient.

A physician may monitor up to three cases simultaneously for other medically necessary monitoring.
Bill only time devoted to the applicable patient.

Unsupported block type: documentation

Unsupported block type: prior_auth

Unsupported block type: billing_rule

Denial Risk

Nonqualifying Spine Procedure

Do not assume coverage for spine procedures that do not meet the policy’s qualifying spine criteria. Monitoring is not medically necessary when the required significant risk and qualifying procedure conditions are absent.

Examples include initial spine surgery, routine decompression and laminotomy when the qualifying criteria are not met.

Denial Risk

Nonqualifying Non-Spine Procedure

Do not bill monitoring for non-spine procedures unless the applicable non-spine medical-necessity criterion is met; services are not medically necessary when that criterion is absent.

Denial Risk

Visual Evoked Potentials Not Covered

Continuous intraoperative monitoring of visual evoked potentials (VEP) is considered not medically necessary and is not covered under this policy.

Visual evoked potentials (VEP).

Denial Risk

Hospital Setting Required

Because of the potential for significant morbidity and the need for optimal recording and interpreting conditions, intraoperative monitoring services must be performed in the hospital setting only.

Non-hospital settings do not meet the policy’s setting requirement.

Billing Rule

Nonreimbursable Billing Arrangement

Claims submitted by the operating surgeon for intraoperative monitoring in addition to the surgical procedure will not be reimbursed. Reimbursement is also not provided for “incident to” care in the hospital setting.

Do not submit the monitoring service as an additional operating-surgeon service.
Do not bill monitoring as incident-to care.

Denial Risk

CPT 95941 Is Not Covered

CPT 95941 is not covered under Coding Policy 89, Intraoperative Neurophysiology.

CPT 95941: not covered.

Denial Risk

Lumbar Below L1-L2 and Cervical Surgery Denial Risk

CPT 95940 and HCPCS G0453 may deny as not medically necessary when performed during lumbar surgery below spinal column level L1-L2 and/or during cervical spine surgery, subject to the policy’s qualifying criteria and diagnosis rules.

Lumbar surgery below L1-L2 when qualifying criteria are not met.
Cervical spine surgery when the high-risk criterion is not met.

Billing Rule

Train of Four Testing Is Not Separately Billable

CPT 95937, neuromuscular junction testing and Train of Four testing, is a routine part of anesthesia care and is not separately billable.

Do not separately bill Train of Four testing.

Billing Rule

Do Not Combine Specified EMG Codes with SSEP

Do not bill EMG CPT codes 95860, 95861, 95863 or 95864 together with SSEP CPT 95938 for the same episode of intraoperative monitoring.

Affected EMG codes: 95860, 95861, 95863 and 95864.
SSEP code: 95938.

Denial Risk

Unlisted-Code Denial and Authorization Risk

Unlisted codes submitted for noncovered services addressed by this policy will be denied as not covered. Unlisted codes for potentially covered services are reviewed for medical necessity, coding and pricing, and prior authorization is recommended before service.

Noncovered service: denial as not covered.
Potentially covered service: obtain advance authorization when possible.

Denial Risk

Not Medically Necessary Diagnosis and Surgical-Site Exclusions

CPT 95940 and HCPCS G0453 will deny as not medically necessary and not covered when billed with the listed diagnosis codes for lumbar surgery below L1-L2 or cervical surgery.

Examples of listed diagnoses include M43.26, M43.27, M43.28, M43.5X6, M43.5X7, M43.5X8, M45.6, M45.7, M45.8, M46.26, M46.27, M46.28, C41.4, D16.8 and G83.4.
Apply the complete not-medically-necessary diagnosis list in the policy.

Denial Risk

Specified Diagnosis and Surgery Combinations Are Not Covered

CPT 95940 and HCPCS G0453 are not covered and will deny as not medically necessary when billed with the specified diagnosis and surgery combinations identified in the policy’s Not Medically Necessary list.

The exclusion list includes the diagnosis and injury-code combinations shown in the policy appendix, including applicable M-, Q- and S-code combinations.
Review the complete list before billing lumbar surgery below L1-L2 or cervical surgery.

Policy Background

Intraoperative neurophysiological testing can help identify or prevent neurologic complications during surgery involving the nervous system, its blood supply, or adjacent tissue. Monitoring may identify new neurologic impairment, help distinguish functional neural structures near a tumor, and demonstrate which neural tracts remain functional, providing information that can support a more thorough or careful surgical intervention.

Definitions and Monitoring Terms

Myelopathy

DefinitionMyelopathy is any neurological deficit related to a spinal cord injury.

Clinical symptomsSymptoms may include bowel or bladder incontinence, hand clumsiness, frequent falls, and urinary urgency.

Objective signsObjective signs may include Hoffman sign, hyperreflexia, and increased tone or spasticity.

Qualified monitoring physician

Required roleThe monitoring physician must be a physician other than the operating surgeon, technical or surgical assistant, or anesthesiologist rendering the anesthesia.

Monitoring responsibilityThe physician supervises the intraoperative neurophysiological monitoring service.

Anesthesia separationThe anesthesiologist rendering anesthesia may not serve as the qualified monitoring physician.

Remote monitoring

Remote-site definitionMonitoring may be performed from a remote site.

Operating-room technicianA trained technician must be continuously present in the operating room.

Real-time communicationThe technician and supervising physician must have physical or electronic real-time communication capability.

Physician accessThe remotely supervising physician must be able to view baseline testing and monitoring tracings in real time, including tracings from earlier in the case.

Communication requirementsRoutine real-time auditory or written communication with the operating room and telephone access to the monitoring technologist, operating surgeon, and anesthesiologist are required.

Remote intraoperative neurophysiological monitoring

Service definitionRemote intraoperative neurophysiological monitoring consists of professional services provided from outside the operating room with focused attention on one patient.

Billing intervalThe service is billed per 15-minute interval using HCPCS G0453.

ContinuityThe service does not need to be continuous.

Time requirementAt least 8 minutes of focused care are required to bill a 15-minute interval.

MIOM

DefinitionMultimodality intraoperative monitoring includes somatosensory evoked potential and motor evoked potential recordings.

Surgical contextMIOM is used during spinal cord or spinal column surgery.

Diagnostic purposeMIOM is a reliable and valid diagnostic adjunct to assess spinal cord integrity when used for that purpose.

SSEP

Full termSSEP means somatosensory evoked potential.

Clinical useSSEP recordings are used as a diagnostic adjunct to assess or describe spinal cord integrity.

Surgical contextSSEP recordings may be used during spinal cord or spinal column surgery.

MEP

Full termMEP means motor evoked potential.

Clinical useMEP recordings are used for cortical or subcortical mapping and monitoring.

At-risk structuresMEPs may be used during surgeries that risk motor injury to the brain, brainstem, spinal cord, or facial nerve.