Neurophysiological studies is a generic term for objective tests performed via sophisticated electronic equipment to detect various neurological dysfunctions. They include the following studies: Electroencephalography (EEG) - 95812-95813, 95816-95822, 95827, 95950, 95951, 95954,95956
Evoked response audiometry (ERA) - 92585, 92586
Visual evoked potential (VEP) - 95930
Central auditory testing - 92589
Somatosensory evoked potential (SEP) testing -95925, 95926, 95927 These tests may be reimbursed individually whether performed independently or
in conjunction with each other. (The above codes represent testing performed in a nonoperative setting.) NOTE: Evoked response audiometry (92585, 92586) can also be reported as:
Brain stem auditory evoked response (BAER)
Electrophysiological response audiometry
Electrical response audiometry
Evoked potential audiometry
Low or high level biophysical EEG
If a physician reports any of these services in addition to the evoked response audiometry, the charges should be combined and processed under code 92585.Magnetoencephalography (MEG) (95965, 95966, 95967) measures neurological activity of the brain using magnetic fields. It is used for fundamental study of the brain, and for clinical studies and assessment of patients with specific neurological disorders. MEG is a noninvasive functional imaging technique in which the weak magnetic forces associated with the electrical activity of the brain are recorded externally on the scalp. Using mathematical modeling, the recorded data are then analyzed to provide an estimated location of the electrical activity. This information can be superimposed on an anatomic image of the brain, typically an MRI, to produce a functional/anatomic image of the brain, referred to as magnetic source imaging or MSI (S8035). The primary advantage of MSI is that while the conductivity and thus measurement of electrical activity as recorded by the EEG is altered by surrounding brain structures, the magnetic fields are not. Therefore, MSI permits a high resolution image. MEG and MSI studies are considered investigational/experimental and are not covered. A participating, preferred, or network provider can bill the member for the denied services. Sufficient clinical trials have not been performed to define the test's effectiveness. Intraoperative neurophysiology monitoring is used to identify complications to the nervous system during certain surgical procedures. Evoked responses are constantly monitored for changes which could imply damage to the nervous system. The intent of this monitoring is to alert the surgeon so that he may possibly alter the surgical procedure to avoid permanent neurological damage. Intraoperative neurophysiology monitoring should be reported under procedure code 95920, regardless of the specific monitoring performed (e.g., brainstem auditory evoked response, somatosensory evoked potentials, etc.) If any of the testing codes addressed above are reported in conjunction with 95920, the services should be combined and processed under 95920 (e.g., 95925 + 95920 = 95920). Intraoperative neurophysiology monitoring is an eligible service when it is performed inpatient by an eligible professional provider for any of the following indications:
- Acoustic neuroma
- Anterior cervical corpectomy
- Carotid endarterectomy
- Cerebral vascular aneurysms
- Cervical or thoracic myelopathy
- Dorsal rhizotomy
- Exploration of peripheral nerve neuroma
- Fracture of the spine
- Hemifacial spasm, 7th nerve decompression operation
- Herniated nucleus pulposus with spinal cord compression and wedge graft surgery following anterior cervical discectomy
- Leg lengthening procedure
- Most spinal instrumentation procedures
- Scoliosis
- Spinal arteriovenous malformation
- Spinal cord trauma
- Spinal stenosis
- Spondylolisthesis
- Spondylosis
- Syringomyelia
- Tethered cord
- Thoracic disc disease
- Trigeminal neuralgia, 5th nerve decompression operation
- Tumor of the CNS or peripheral NS
- Unstable spine
Individual consideration may be given for indications other than those above. Reimbursement for this monitoring may be made only for the actual time the physician was physically present in the operating room.
NOTE: - When intraoperative neurophysiology monitoring is performed by the surgeon, assistant surgeon or anesthesiologist, it is considered integral to the surgery/anesthesia. (See Medical Policy Bulletin G-13 for additional guidelines on monitoring during surgery.)
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