63042
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
18.29
Facility
$1219.80
Non-Facility
$1219.80
Documentation Required
- A logbook should be completed for each patient and include the time of the procedure, the time of each surgical manipulation of the central or peripheral nervous system, and the name, dose and times of anesthetics administered which may affect the central or peripheral nervous system or muscle.
- Baseline tracings should be obtained prior to the surgical intervention; pre-procedural baseline studies are performed immediately prior to the proposed surgery for comparison with the studies performed during surgery.
- Each baseline study should be reported only once per operative session (American Academy of Neurology).
- Monitoring must be performed by qualified personnel acting within the scope of their license/certification as defined by state law or appropriate authorities; the IOM team must include a trained clinical neurophysiologist (MD or DO).
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).
1 Active Policy
CIGNA-0509 — Intraoperative Monitoring - (0509)
Related Codes
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