Appeal type: Testing
Decision: Unfavorable

 
We decided that the Plan does not have to pay for remote intraoperative neurophysiology monitoring provided 
on June 15, 2022. 
 
You asked the Plan to pay for remote intraoperative neurophysiology monitoring. You say that remote 
intraoperative neurophysiology monitoring was medically necessary. The Plan denied your request. The Plan 
says remote intraoperative neurophysiology monitoring is experimental. 
 
The Plan must follow Medicare rules. Medicare rules say that items and services that are not medically 
necessary are not covered.  
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request to pay for remote intraoperative neurophysiology 
monitoring. Our reviewer says that the requested remote intraoperative neurophysiology monitoring is not considered medically reasonable and necessary. Our physician reviewer found that the enrollee underwent a 
right frontal craniotomy. The enrollee had presented with a seizure with associated gait abnormalities. 
Intraoperative neurophysiologic monitoring (IONM) describes a variety of procedures used to monitor the 
integrity of neural pathways during high-risk neurosurgical, orthopedic, and vascular surgeries. It involves the 
detection of electrical signals produced by the nervous system in response to sensory or electrical stimuli to 
provide information about the functional integrity of neuronal structures. The principal goal of IONM is the 
identification of nervous system impairment on the assumption that prompt intervention will prevent permanent 
deficits. Correctable factors at surgery include circulatory disturbance, excess compression from retraction, 
bony structures, hematomas, or mechanical stretching. The technology is continuously evolving with 
refinements in equipment and analytic techniques, including recording, with several patients monitored under 
the supervision of a physician who is outside the operating room. Intraoperative neurophysiologic monitoring 
includes Somatosensory-evoked potentials (SSEP), Motor-evoked potentials (MEP) 
(using transcranial electrical stimulation), Brainstem auditory-evoked potentials (BAEP), Electromyogram 
monitoring (EMG) of cranial nerves, Electroencephalogram Monitoring (EEG) and Electrocorticography 
(EcoG) and may be medically necessary during spinal, intracranial or vascular procedures. The code G0453 
should be billed only for undivided attention by a monitoring provider to a single member and not for 
simultaneous attention by the monitoring provider to more than one member. This code can be billed in 
multiple units to account for the cumulative time spent exclusively monitoring a single member. Therefore, 
code G0453 can be billed for 15-minutes of continuous monitoring of the member followed by an additional 
15-minutes later in the same members procedure, equal to a total of 30-minutes or two units. G0453 may not be 
billed for 7 minutes or less. Note, this code is reported based on the time spent for monitoring only, and not for 
the number of baseline tests that are rendered, or the parameters monitored. In this case, the enrollee underwent 
a right frontal craniotomy. Intra-operative EMG is considered experimental and investigational in this case 
because its effectiveness for this indications has not been established. The review has determined that the 
remote intraoperative neurophysiology monitoring at issue in this case was not medically reasonable or 
necessary. 
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of remote intraoperative neurophysiology monitoring have not been met. 
Therefore, we decided that the Plan does not have to pay for remote intraoperative neurophysiology monitoring 
(CPT G0453) provided on June 15, 2022.