Does 95940 require prior authorization?

No, 95940 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 95940?

Medicare facility rate: $26.72. Non-facility rate: $26.72. Work RVU: 0.60.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.60

Facility

$26.72

Non-Facility

$26.72

All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include patient identification and dates of service.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient's medical record and available to the contractor upon request.

Continuous intraoperative neurophysiologic monitoring provided one-on-one in the operating room (CPT 95940) is covered when it supports the covered indications in LCD L35003.
Report continuous intraoperative neurophysiologic monitoring in the operating room (95940) in addition to monitoring services provided from outside the operating room (G0453); coverage includes interpretation of baseline studies and removal of electrodes at the end of the procedure when supporting the LCD indications.
Reimbursement may be made for covered intraoperative monitoring when performed at POS 19, POS 21, POS 22, or POS 24.
Intraoperative neurophysiological testing is billable only when coverage criteria and medical necessity in related LCD L34623 are met.
Covered for resection of epileptogenic brain tissue or brain tumor to identify and prevent neurologic injury.
Intraoperative neurophysiological testing is covered for surgery on the aortic arch, its branch vessels, thoracic aorta, or internal carotid artery when there is risk of cerebral ischemia.

L34623 — Intraoperative Neurophysiological Testing

J05

A57604 — Billing and Coding: Intraoperative Neurophysiological Testing

J05

L35003 — Intraoperative Neurophysiological Testing

J12

A56722 — Billing and Coding: Intraoperative Neurophysiological Testing

J12

AMBETTER-CP.MP.134

Ask Verity about documentation requirements, denial risks, or coverage in your state.