Highmark Medical Policy Bulletin |
Section: | Diagnostic Medical |
Number: | M-13 |
Topic: | Neurophysiological Studies |
Effective Date: | January 1, 2001 |
Issued Date: | January 1, 2001 |
Date Last Reviewed: |
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 These tests may be reimbursed individually whether performed independently or NOTE: Evoked response audiometry (92585, 92586) can also be reported as: Brain stem auditory evoked response (BAER) 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. 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:
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 to be integral to the surgery/anesthesia. (See Medical Policy Bulletin G-13 for additional guidelines on monitoring during surgery.) |
92585 | 92586 | 92589 | 95812 | 95813 | 95816 |
95819 | 95822 | 95827 | 95920 | 95925 | 95926 |
95927 | 95930 | 95950 |
Traditional (UCR/Fee Schedule) Guidelines
Comprehensive/Wraparound/PPO Guidelines
Managed Care (HMO/POS) Guidelines
PRN References |
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