62292
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
9.24
Facility
$510.03
Non-Facility
$510.03
Documentation Required
- The policy does not specify particular medical-record documentation (e.g., required test results or clinical notes) that would render these procedures covered; instead, it states they are unproven and not medically necessary.
- General instruction: When deciding coverage, reference the member-specific benefit plan document and any applicable federal or state mandates; in the event of conflict, the member-specific plan governs.
- If this policy is applied to Medicare Advantage in absence of an NCD/LCD, MAO coverage determinations should rely on objective evidence-based rationale and authoritative evidence (Medicare IOM Pub. No. 100-16, Ch. 4, §90.5).
- Coding note/documentation: Functional anesthetic discography should be billed with CPT code 64999 (billing clarification provided).
Key Coverage Criteria
- Continuous intraoperative neurophysiologic monitoring (IOM) is considered medically necessary when ALL of the following criteria are met: IOM is performed by either a licensed physician trained in clinical neurophysiology (e.g., a neurologist, physiatrist) or a trained technologist who is practicing within the scope of his/her state license /certification as defined by state law or appropriate authorities and is working under the direct supervision of a physician trained in neurophysiology and i [...]
- Continuous intraoperative neurophysiologic monitoring (IOM) is considered medically necessary when ALL of the following criteria are met: IOM is interpreted by a licensed physician trained in clinical neurophysiology, other than the operating surgeon or anesthesiologist, who is either physically in attendance in the operating suite or present by means of a real-time remote mechanism for all electroneurodiagnostic (END) monitoring situations and is immediately available to interpret the recording [...]
- Continuous intraoperative neurophysiologic monitoring (IOM) is considered medically necessary when ALL of the following criteria are met: Monitoring is conducted and interpreted real-time (either on-site or at a remote location) and continuously communicated to the surgical team.
- Continuous intraoperative neurophysiologic monitoring (IOM) is considered medically necessary when ALL of the following criteria are met: There is significant risk of brain, spinal cord, cranial nerve, or major peripheral nerve injury during a surgical procedure.
- Monitoring of a cranial nerve during head and/or 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).
- Monitoring of recurrent laryngeal nerve function during high-risk thyroid surgery (e.g., complete resection of a lobe of the thyroid, removal of the entire gland, malignancy, or following a prior thyroid surgery where there is scar tissue surrounding the laryngeal nerve).
7 Active Policies
AMBETTER-CP.MP.115 — Discography
CARELON-interventional-pain-management-2025-07-26 — Interventional Pain Management
UHC-POL-epiduroscopy-epidural-lysis-adhesions-discography — Epiduroscopy, Epidural Lysis of Adhesions, and Discography
UMR-POL-UMR-epiduroscopy-epidural-lysis-adhesions-discography — Epiduroscopy, Epidural Lysis of Adhesions, and Discography
Related Codes
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