95941
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- All documentation must be maintained in the patient's medical record and available to the contractor upon request.
- Every page of the medical record must be legible and include appropriate patient identification (e.g., complete name, dates of service).
- The record must include the physician or non-physician practitioner responsible for providing the care of the patient.
- The patient's medical record should document the time spent in monitoring in correlation to the surgery performed.
Key Coverage Criteria
- 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.
- Covered for resection of brain tissue adjacent to the primary motor cortex when brain mapping is required to preserve motor function.
- Covered for protection of cranial nerves during surgery (including optic, trigeminal, facial, and auditory nerve procedures and cavernous sinus tumor resections).
- Covered for otologic procedures where neural structures are at risk (e.g., oval or round window graft, endolymphatic shunt for Ménière's disease, vestibular section, microvascular decompression of cranial nerves).
7 Active Policies
A57604 — Billing and Coding: Intraoperative Neurophysiological Testing
J05
L34623 — Intraoperative Neurophysiological Testing
J05
AETNA-CPB-0502 — Nerve Conduction Studies
AMBETTER-CP.MP.134 — Evoked Potential Testing
ANTHEM-CG-SURG-104 — CG-SURG-104 Intraoperative Neurophysiological Monitoring
Related Codes
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