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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 based on the information in the scientific literature, intra-operative testing may be considered 
reasonable and necessary for the following: 
 
1. 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 
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 
 
-Resection of tumors involving the cranial nerves 
-Cavernous sinus tumors 
-Microvascular decompression of cranial nerves 
-Skull base surgery in the vicinity of the cranial nerves and surgeries of the foramen magnum 
-Oval or round window graft 
 
5. Endolymphatic shunt for Meniere's disease 
6. Vestibular section for vertigo 
7. Correction of scoliosis or deformity of spinal cord involving traction of the cord 
8. 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 
9. Spinal instrumentation requiring pedicle screws or distraction 
10. 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 
11. Spinal cord tumors and spinal fractures (with the risk of cord compression) 
12. Neuromas of peripheral nerves of brachial plexus, when there is risk to major sensory or motor nerves 
13. Surgery or embolization for intracranial AV malformations 
14. Surgery for arteriovenous malformation of spinal cord 
15. Embolization of bronchial artery AVMs or tumors 
16. Cerebral vascular aneurysms 17. Surgery for intractable movement disorders 
18. Arteriography, during which there is a test occlusion of the carotid artery 
19. Circulatory arrest with hypothermia (does not include surgeries performed under circulatory bypass [e.g., 
CABG, ventricular aneurysms]) 
20. Distal aortic procedures, where there is risk of ischemia to spinal cord 
21. Leg lengthening procedures, where there is traction on sciatic nerve or other nerve trunks 
22. Basal ganglia movement disorders 
23. Surgery as a result of traumatic injury to spinal cord/brain 
24. Deep brain stimulation, and 
15. Certain thyroid surgeries (see below for additional guidance) 
 
You can find this rule in the Local Coverage Determination (LCD) - Intraoperative Neurophysiological Testing 
(L35003) - Effective November 14, 2019. 
 
The rules say that providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
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.