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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 state that based on information in the scientific literature, intra-operative testing may be considered 
reasonable and necessary for the following: 
 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 
 Resection of epileptogenic brain tissue or tumor 
 Resection of brain tissue close to the primary motor cortex and requiring brain mapping 
 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 
 Endolymphatic shunt for Meniere's disease 
 Vestibular section for vertigo 
 Correction of scoliosis or deformity of spinal cord involving traction of the cord 
 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 
 Spinal instrumentation requiring pedicle screws or distraction 
 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 
 Spinal cord tumors and spinal fractures (with the risk of cord compression) 
 Neuromas of peripheral nerves of brachial plexus, when there is risk to major sensory or motor nerves 
 Surgery or embolization for intracranial AV malformations 
 Surgery for arteriovenous malformation of spinal cord 
 Embolization of bronchial artery AVMs or tumors 
 Cerebral vascular aneurysms  Surgery for intractable movement disorders 
 Arteriography, during which there is a test occlusion of the carotid artery 
 Circulatory arrest with hypothermia (does not include surgeries performed under circulatory bypass 
[e.g., CABG, ventricular aneurysms]) 
 Distal aortic procedures, where there is risk of ischemia to spinal cord 
 Leg lengthening procedures, where there is traction on sciatic nerve or other nerve trunks 
 Basal ganglia movement disorders 
 Surgery as a result of traumatic injury to spinal cord/brain 
 Deep brain stimulation, and 
 Certain thyroid surgeries (see below for additional guidance) 
Intraoperative neurophysiologic monitoring during thyroid surgery is considered reasonable and necessary if 
the monitoring service adheres to the essential standards described above, and the surgical procedure involves 
the high-risk total removal of a complete lobe of the thyroid, removal of the entire gland, or involves re-entry 
(re-operation) to a prior surgical field where scar tissue obscures the visual path of the recurrent laryngeal 
nerve. The surgeries described here are most appropriately reported as a total removal of thyroid lobe on one 
side of the neck, removal of thyroid, removal of thyroid and surrounding lymph nodes or removal of remaining 
thyroid tissue. The contractor reserves the right to remove coverage for monitoring during thyroid surgery if the 
literature ultimately does not support this monitoring. You can find this rule at Centers for Medicare and 
Medicaid Services, Local Coverage Determination (LCD) L35003- Intraoperative Neurophysiological Testing. 
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.