CG-SURG-104 Intraoperative Neurophysiological Monitoring

This policy addresses intraoperative neurophysiological monitoring (IONM) during surgery, including tests such as SSEP, BAEP, EMG, EEG, ECoG, direct cortical stimulation, nerve conduction studies, and MEP. It is medically necessary when used to monitor neural integrity during spinal, neurologic, cranial, or vascular procedures that may compromise neurologic function, with testing tailored to the surgery and to neural pathways likely to be affected. It is not medically necessary when these criteria are unmet, for intraoperative visual-evoked potentials or vestibular evoked myogenic potential testing, or for routine spinal surgery without myelopathy or other complicating risk—except EMG for pedicle screw stimulation.

"Intraoperative neurophysiological monitoring is consideredmedically necessarywhen ALL of the following are met:"

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