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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that medically necessary services are those that are reasonable and necessary for the diagnosis or 
treatment of an illness or injury. Medically necessary services include services to improve the functioning of a 
malformed body member. You can find this rule in the Social Security Act, Section 1862(a)(1)(A). 
The rules say that based on information in the scientific literature, intra-operative testing may be considered 
reasonable and necessary for the following: 
61623; Surgery of the aortic arch, its branch vessels, or thoracic aorta, including carotid artery surgery, when 
there is risk of cerebral or spinal cord ischemia 
61623; Resection of epileptogenic brain tissue or tumor 
61623; Resection of brain tissue close to the primary motor cortex and requiring brain mapping 
61623; Protection of cranial nerves:  
o Resection of tumors involving the cranial nerves 
o Cavernous sinus tumors 
o Microvascular decompression of cranial nerves 
o Skull base surgery in the vicinity of the cranial nerves and surgeries of the foramen magnum 
o Oval or round window graft 
61623; Endolymphatic shunt for Meniere's disease 
61623; Vestibular section for vertigo 
61623; Correction of scoliosis or deformity of spinal cord involving traction of the cord 
61623; Protection of spinal cord where work is performed in close proximity to cord as in the placement or 
removal of old hardware or where there have been numerous interventions 
61623; Spinal instrumentation requiring pedicle screws or distraction 
61623; Decompressive procedures on the spinal cord or cauda equina carried out for myelopathy or 
claudication where function of spinal cord or spinal nerves is at risk 
61623; Spinal cord tumors and spinal fractures (with the risk of cord compression) 
61623; Neuromas of peripheral nerves of brachial plexus, when there is risk to major sensory or motor nerves 
61623; Surgery or embolization for intracranial AV malformations 
61623; Surgery for arteriovenous malformation of spinal cord 
61623; Embolization of bronchial artery AVMs or tumors 
61623; Cerebral vascular aneurysms 
61623; Surgery for intractable movement disorders 
61623; Arteriography, during which there is a test occlusion of the carotid artery 
61623; Circulatory arrest with hypothermia (does not include surgeries performed under circulatory bypass 
[e.g., CABG, ventricular aneurysms]) 
61623; Distal aortic procedures, where there is risk of ischemia to spinal cord 
61623; Leg lengthening procedures, where there is traction on sciatic nerve or other nerve trunks 
61623; Basal ganglia movement disorders 
61623; Surgery as a result of traumatic injury to spinal cord/brain 
61623; Deep brain stimulation, and 
61623; Certain thyroid surgeries (see below for additional guidance) 
You can find this rule at Local Coverage Determination (LCD): Intraoperative Neurophysiological Testing 
(L35003) (eff. 7/25/19). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.