Does G0453 require prior authorization?

No, G0453 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0453?

Medicare facility rate: $27.39. Non-facility rate: $27.39. Work RVU: 0.60.

Verity

`G0453` — Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.60

Facility

$27.39

Non-Facility

$27.39

Documentation Required

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.

Key Coverage Criteria

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.

11 Active Policies

L34623 — Intraoperative Neurophysiological Testing

J05

A57604 — Billing and Coding: Intraoperative Neurophysiological Testing

J05

A56722 — Billing and Coding: Intraoperative Neurophysiological Testing

J12

L35003 — Intraoperative Neurophysiological Testing

J12

WPS-L34623 — Intraoperative Neurophysiological Testing

J8 MAC Part B

NOVITAS-L35003 — Intraoperative Neurophysiological Testing

JL MAC Part B

ANTHEM-CG-SURG-104 — CG-SURG-104 Intraoperative Neurophysiological Monitoring

AETNA-CPB-0502 — Nerve Conduction Studies

AETNA-CPB-0194 — Spinal Cord Stimulation

MED205.011 — Intraoperative Neurophysiologic Monitoring (IONM)

AMBETTER-CP.MP.134 — Evoked Potential Testing

`G0453` — Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

G0453 — Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

`G0453` — Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)