About this policy
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 patient’s 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 patient’s 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.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 95940 | HCPCS | Covered |
| 95941 | HCPCS | Covered |
| G0453 | HCPCS | Covered |
| A18.01 | ICD10CM | Covered |
| C41.2 | ICD10CM | Covered |
| C70.0 | ICD10CM | Covered |
| C70.1 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C72.1 | ICD10CM | Covered |
| C72.21 | ICD10CM | Covered |
| C72.22 | ICD10CM | Covered |
| C72.31 | ICD10CM | Covered |