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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 intraoperative neurophysiological testing may be used to identify/prevent complications 
during surgery on the nervous system, its blood supply, or adjacent tissue. 
 
Monitoring can identify new neurologic impairment, identify, or separate nervous system structures (e.g., 
around or in a tumor), and can demonstrate which tracts or nerves are still functional. Intraoperative 
neurophysiological testing may provide relative reassurance to the surgeon that no identifiable complication 
has been detected up to a certain point, allowing the surgeon to proceed further and provide a more thorough or 
careful surgical intervention than would have been provided in the absence of monitoring. 
 
Some high-risk patients may be candidates for a surgical procedure only if monitoring is available. To establish 
medical necessity the following guidelines must be followed: 
 Intraoperative testing may be indicated with the following types of surgery: 
1. Surgery of the aortic arch, its branch vessels, or thoracic aorta, including internal carotid artery surgery, 
when there is risk of cerebral ischemia 
2. Resection of epileptogenic brain tissue or tumor 
3. Resection of brain tissue close to the primary motor cortex and requiring brain mapping 
4. Protection of cranial nerves: 
a. tumors that are optic, trigeminal, facial, auditory nerves 
b. cavernous sinus tumors 
c. oval or round window graft 
d. endolymphatic shunt for Meniere's disease 
e. vestibular section for vertigo 
f. microvascular decompression of cranial nerves 5. Correction of scoliosis or deformity of spinal cord involving traction on the cord 
6. Protection of spinal cord where work is performed in close proximity to cord as in the removal of old 
hardware or where there have been numerous interventions 
7. Spinal instrumentation requiring pedicle screws or distraction 
8. 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 
9. Resection of: 
a. Spinal cord tumors 
b. Neuromas of peripheral nerves or brachial plexus, when there is risk to major sensory or motor 
nerves 
10. Surgery for: 
a. intracranial AV malformations 
b. arteriovenous malformation of spinal cord 
c. surgery for intractable movement disorders 
d. cerebral vascular aneurysms 
11. Arteriography, during which there is a test occlusion of the carotid artery 
12. Circulatory arrest with hypothermia 
13. Distal aortic procedures, where there is risk of ischemia to spinal cord 
14. Leg lengthening procedures, where there is traction on sciatic nerve or other nerve trunks 
15. Basil ganglia movement disorders 
16. Surgery as a result of traumatic injury to spinal cord/brain 
17. Deep brain stimulation 
You can find this rule at the Medicare Local Coverage Determination (LCD) L34623: Intraoperative 
Neurophysiological Testing. 
 
The rules state that the billing and coding information in this article is dependent on the coverage indications, 
limitations, and/or medical necessity described in the related LCD L34623 Intraoperative Neurophysiological 
Testing. 
 
Documentation Requirements 
All documentation must be maintained in the patients medical record and available to the contractor upon 
request. 
 
Every page of the medical record must be legible and include appropriate patient identification information 
(e.g. complete name, dates of service). The record must include the physician or non-physician practitioner 
responsible for providing the care of the patient. 
 
The patients medical record should document the time spent in monitoring in correlation to the surgery 
performed. 
 
The submitted medical record should support the use of the selected diagnosis code(s). The submitted 
CPT/HCPCS code should describe the service performed. 
 
Utilization Guidelines 
 
Intraoperative neurophysiology monitoring should not be reported by the physician performing the operative 
procedure since it is included in the global package for the surgery. 
 
You can find this rule at the Medicare Local Coverage Article (LCA) A57604: Billing and Coding: 
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.