Highmark Medical Policy Bulletin |
Section: | Diagnostic Medical |
Number: | M-13 |
Topic: | Neurophysiological Studies |
Effective Date: | January 1, 2012 |
Issued Date: | January 2, 2012 |
Date Last Reviewed: | 10/2010 |
Indications and Limitations of Coverage
Neurophysiological studies may be reimbursed individually whether performed independently or in conjunction with each other. However, if a provider reports any neurophysiological studies (92586, 95812, 95813, 95816, 95819, 95822, 95827, 95925, 95926, 95927, 95928, 95929, 95930, 95938, 95939, 95950, 95951, 95954, 95956) in addition to comprehensive evoked response audiometry (92585), the charges should be combined and processed under code 92585 (e.g., 92585 + 92589 = 92585). Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines. Magnetoencephalography and Magnetic Source Imaging
*Medically refractory epilepsy refers to the failure of adequate trials of different classes of FDA approved antiepilepsy medications to control seizure activity, when taken in appropriate doses and carefully monitored for effectiveness and patient compliance. MEG/MSI is also considered eligible for use in presurgical functional brain mapping (PSFBM)(96020) for the preoperative evaluation of intracranial lesions located near the eloquent cortex or essential functional areas of the brain. Other uses of MEG/MSI are considered experimental/investigational, and are not covered. A participating, preferred, or network provider can bill the member for the non-covered service. Intraoperative Neurophysiology Monitoring (INM) Intraoperative neurophysiology monitoring is an eligible service when it is performed by either a licensed physician (MD or DO) or an INM certified technician for any of the following indications: Intracranial Surgery
Orthopedic Surgery
Otolaryngolic Procedures
Peripheral Nerve Surgery
Robotic Assisted Procedures
Spinal Procedures
Vascular/Cardiovascular/Endovascular Procedures
Intraoperative neurophysiology monitoring will be considered eligible when performed by either a licensed physician (MD or DO) or an INM certified technician. The actual interpretation of the INM data will be considered eligible only when it has been performed by a licensed physician (MD or DO). The physician must be performing the interpretation in real time. The physician may be in the O.R. suite or at a remote site with the INM data relayed via digital transmission or closed circuit television. When digital transmission or closed circuit television is used, there must be the ability for continuous or immediate contact with the operating surgeon to ensure that information about the patient’s status can be immediately communicated. The interpreting physician must be someone other than the operating physician (surgeon), the technical surgical assistant, or the anesthesiologist rendering the anesthesia for the procedure. The written interpretation of the INM data must be documented within the patient’s medical record. Description Neurophysiological studies is a generic term for objective tests performed via sophisticated electronic equipment to detect various neurological dysfunctions. They include the following studies:
(The above codes represent testing performed in a nonoperative setting.) NOTE: Evoked response audiometry (92585, 92586) can also be reported as:
Magnetoencephalography MEG and MSI have been found to be useful in the anatomical localization of areas of seizure focus and epileptogenic lesions of the brain, and in predicting outcomes in surgical resections for intractable temporal lobe epilepsy and brain lesions. 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 functional/anatomic image. This allows precise localization of epileptiform activity and anatomical identification of brain lesions. Use of MEG/MSI in presurgical functional brain mapping (PSFBM) helps to determine whether surgical resection of a brain lesion is feasible, and improves the safety and accuracy of tumor resection while reducing the risk of postoperative functional deficits. Intraoperative Neurophysiology Monitoring |
92585 | 92586 | 95812 | 95813 | 95816 | 95819 |
95822 | 95827 | 95920 | 95925 | 95926 | 95927 |
95928 | 95929 | 95930 | 95938 | 95939 | 95950 |
95951 | 95954 | 95956 | 95965 | 95966 | 95967 |
96020 | S8035 |
Traditional (UCR/Fee Schedule) Guidelines
This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits are determined by the Federal Employee Program. |
Comprehensive / Wraparound / PPO / Major Medical Guidelines
Any reference in this bulletin to non-billable services by a network provider may not be applicable to Major Medical.
Managed Care (HMO/POS) Guidelines
PRN
03/1994, Intraoperative neurophysiology testing, coding for |
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Neurology, Volume 62, 03/2004 Magnetoencephalography Source Localization and Surgical Outcome in Temporal Lobe Epilepsy, Elsevier Ireland, Ltd, 06/2004 Application of Magnetoencephalography in Epilepsy Patients with Widespread Spike or Slow-wave Activity, Epilepsia, Volume 46, Number 8, 2005 Detection of Epileptiform Activity by Human Interpreters: Blinded Comparison Between Electroencephalography and Magnetoencephalography, Epilepsia, Volume 46, Number 1, 2005 Dynamic Statistical Parametric Mapping for Analyzing the Magnetoencephalographic Epileptiform Activity in Patients with Epilepsy, Journal of Child Neurology, Volume 20, 04/2005 Toward the Substitution of Invasive Electroencephalography in Epilepsy Surgery, The Journal of Clinical Neurophysiology, Volume 22, Number 4, 08/2005 Magnetic Source Imaging Localizes Epileptogenic Zone in Children with Tuberous Sclerosis Complex, Neurology, Volume 66, 04/2006 Reliability of Language Mapping with Magnetic Source Imaging in Epilepsy Surgery Candidates, Elsevier Ireland, Ltd, 04/2006 Magnetoencephalography/Magnetic Source Imaging, MPRM, Policy 6.01.21, 12/12/2006 Kakigi R, Hoshiyama M, Shimojo M, Naka D, Yamasaki H, Watanabe S, Xiang J, Maeda K, Lam K, Itomi K, Nakamura A. 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Grover KM, Bowyer SM, Rock ML, Rosenblum KM, Moran JE, Smith BJ, Barkley GL. Retrospective review of MEG visual evoked hemifield responses prior to resection of temporo-parieto-occipital lesions. Journal of Neuro-Oncology. 2005. Makela J, Forss N, Jaaskelainen J, Kirveskari E, Korvenoja A, Paetau R. Magnetoencephalography in neurosurgery. Neurosurgery. 2006;59:493-511. Grummich P, Nimsky C, Pauli E, Buchfelder M, Ganslandt O. Combining fMRI and MEG increases the reliability of pre-surgical language localization: a clinical study of the difference between and congruence of both modalities. Neuroimage. 2006;32:1793-1803. Korvenoja A, Kirveskari, Aronen HJ, Avikainen S, Brander A Huttunen J, Ilmoniemi RJ, Jaaskelainen JE, Kovala T, Makela JP, Salli E, Seppa M. Sensorimotor cortex localization: comparison of magnetoencephalography, functional MR imaging, and intraoperative cortical mapping. Radiology. 2006;241:213-22. Kamada K, Sawamura Y, Takeuchi F, Kuriki S, Kawai K, Morita A, Todo T. Expressive and receptive language areas determined by a non-invasive reliable method using functional magnetic resonance imaging and magnetoencephalography. www.neurosurgery-online.com. 2007;60:296-306. Larsen S, Kikinis R, Talos IF, Weinstein D, Wells W, Golby A. Quantitative comparison of functional MRI and direct electrocortical stimulation for functional mapping. International Journal of Medical Robotics and Computer-Assisted Surgery. 2007;3:262-70. Stippich C, Rapps N, Dreyhaupt J, Durst A, Kress B, Nennig E, Tronnier VM, Sartor K. Localizing and lateralizing language in patients with brain tumors: feasibility of routine preoperative functional MR imaging in 81 consecutive patients. Radiology. 2007;243:828-36. Tharin S, Golby A. Functional brain mapping and its applications to neurosurgery. Neurosurgery. 2007;60:185-201. Chakraborty A, McEvoy AW. Presurgical functional mapping with functional MRI. Current Opinion Neurology. 2008;24:446-51. Bizzi A, Blasi V, Falini A, Ferroli P, Cadioli M, Danesi U, Aquino D, Marras C, Caldiroli D, Broggi G. Presurgical functional MR imaging of language and motor functions: validation with intraoperative electrocortical mapping. Radiology. 2008;248:579-89. Knowlton RC. Can Magnetoencephalography aid epilepsy surgery? Epilepsy Curr. 2008;8(1):1-5. Lau M, Yam D, Burneo JG. A systematic review on MEG and its use in the presurgical evaluation of localization-related epilepsy. Epilepsy Res. 2008;79(2-3):97-104. Munoz-Yunta JA, Ortiz T, Palau-Baduell M, Martin-Munoz L, et al. Magnetoencephalographic pattern of epileptiform activity in children with early-onset autism spectrum disorders. Clin Neurophysiol. 2008;119(3):626-34. Sutherling WW, Mamelak AN, Thyerlei D, et al. Influence of magnetic source imaging for planning intracranial EEG in epilepsy. Neurology. 2008;71(13):990-6. Bagic A, Funke ME, Ebersole J; ACMEGS Position Statement Committee. American Clinical MEG Society (ACMEGS) position statement: The value of magnetoencephalography (MEG)/magnetic source imaging (MSI) in noninvasive presurgical evaluation of patients with medically intractable localization-related epilepsy. J Clin Neurophysiol. 2009;26(4):290-293. Chang EF, Nagarajan SS, Mantle M, et al. Magnetic source imaging for the surgical evaluation of electroencephalography-confirmed secondary bilateral synchrony in intractable epilepsy. J Neurosurg. 2009;111(6):1248-56. Doss RC, Zhang W, Risse GL. Lateralizing language with magnetic source imaging: validation based on the Wada test. Epilepsia. 2009;50(10):2242-8. Frye RE, Rezaie R, Papanicolaou AC. Functional Neuroimaging of language using magnetoencephalography. Phys Life Rev. 2009;6(1):1-10. Ince NF, Pellizzer G, Tewfik AH et al. Classification of schizophrenia with spectro-temporo-spatial MEG patterns in working memory. Clin Neurophysiol. 2009;120(6):1123-34. American Medical Association House of Delegates Resolution: 201. Intraoperative Neurophysiologic Monitoring. Published May 06, 2009. Accessed October 07/2010. Knowlton RC, Razdan SN, Limdi N, et al. Effect of epilepsy magnetic source imaging on intracranial electrode placement. Ann Neurol. 2009;65(6):716-23. American Academy of Neurology (AAN). Magnetoencephalography (MEG) Policy. May 2009. Available at: http://www.aan.com/globals/axon/assets/5641.pdf. Accessed August 2010. American College of Radiology. ACR Appropriateness Criteria®. Epilepsy. (2006). Available at:http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonNeurologicImaging/EpilepsyDoc3.aspx. Accessed August 24, 2010. Besga A, Ortiz L, Fernandez A, et al. Structural and functional patterns in healthy aging, mild cognitive impairment, and Alzheimer’s disease. Alzheimer Dis Assoc Disord. 2010;24(1):1-10. Ray A, Boyer SM. Clinical applications of magnetoencephalography in epilepsy. Ann Indian Acad Neurology. 2010;13(1):14-22. Schwartz ES, Edgar JC, Gaatz WC, et al. Magnetoencephalography. Pediatr Radiol. 2010;40(1):50-8. Stam CJ. Use of magnetoencephalography (MEG) to study functional brain networks in neurodegenerative disorders. J Neurol Sci. 2010;289(1-2):128-34. Williams MA, Sachdev PS. Magnetoencephalography in neuropsychiatry: ready for application? Curr Opin Psychiatry. 2010.[Epub ahead of print] American Academy of Neurology (AAN). Principles of Coding for Intraoperative Neurophysiologic Monitoring (IOM) and Testing - from the American Academy of Neurology Professional Association - Model Medical Policy 2009. Available at: http://www.aan.com/globals/axon/assets/4748.pdf. Accessed September 23, 2010. American Academy of Otolaryngology - Head and Neck Surgery. Facial nerve monitoring policy. Available at http://www.aaohns.org/Practice/policy/FacialNerveMonitoring.cfm. Accessed September 23, 2010. American Academy of Neuromuscular and Electrodiagnostic Medicine (AANEM). Credentialing of physicians as electrodiagnostic medicine consultants; position statement. Available from http://www.aanem.org/practice/positionstatements.aspx. Accessed September 23, 2010. American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Proper performance and interpretation of electrodiagnostic studies; position statement. Available from http://.www.aanem.org/practice/positionstatement.aspx. Accessed September 23, 2010. American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Recommended policy for electrodiagnostic medicine, position statement. Available from http://www.aanem.org/practice/positionstatements.aspx. Accessed September 23, 2010. American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). The role of the intraoperative monitoring team [Position Statement]. Available from http://www.aanem.org/Practice/Position-Statements.aspx. Accessed September 23, 2010. American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Who is qualified to practice electrodiagnostic medicine? Position statement. Available from http://www.aanem.org/practice/positionstatements.aspx. Accessed September 23, 2010. American Society of Electroneurodiagnostic Technologists, Inc. Scope of practice for electroneurodiagnostic technology. Available at http://aset.org/files/public/scope_of_Practice.pdf. Accessed September 23, 2010. American Speech-Language-Hearing Association. (1992). Neurophysiologic Intraoperative Monitoring [Position Statement]. Available from http://www.asha.org/policy. Accessed September 23, 2010. American Society of Electroneurodiagnostic Technologists, Inc. (ASET). Simultaneous Intraoperative Monitoring. Available at: http://aset.org/i4a/pages/index.dfm?pageid=3523. Accessed September 23, 2010. American Academy of Audiology. Scope of Practice. Available at: http://www.audiology.org/resources/documentlibrary/Pages/ScopeofPractice.aspx. Accessed October 07, 2010. The American Academy of Otolaryngology - Head and Neck Surgery, Inc. (AAO-HNS). Coding for Intraoperative Neurophysiology Testing. Available at: http://www.aaohns.org/Practice/Coding-for-Intraoperative-Neurophysiology-Testing.cfm. Accessed October 07, 2010. American Board of Neurophysiologic Monitoring (ABNM). Available at: http://abnm.info/PandPreqapp.htm. Accessed October 07, 2010. The American Chiropractic Association. Scope of Practice. Available at: http://222.acatoday.org/level2_css.cfm?T1ID=10&T2ID=117. Accessed October 07, 2010. American Clinical Neurophysiology Society (ACNS). Recommended Standards for Neurophysiologic Intraoperative Monitoring - Principles. Published October 2009. Available at: http://acns.org/pdfs/Guidelines%2011A.pdf. Accessed October 07, 2010. The American Physical Therapy Association (APTA). Physical Therapist Scope of Practice. Available at: http://www.apta.org/AM/Template.cfn?section=Professional.Resources&contentID=67455&template=/CM/ContentDisplay.cfm. Pennsylvania Code - Physician Assistants. Available at: http://www.pacode.com/secure/data/049/chapter18/subchapDtoc.html. Accessed October 07, 2010. The Pennsylvania State Board of Chiropractic. Scope of Practice. Available at: http://directory.fclb.org/US/Pennsylvania/tabid/203/Default.aspx. Accessed October 07, 2010. American Board of Registered Electroneurodiagnostic Technologists (ABRET). CNIM Exam Eligibility Requirements. Available at: http://abret.org/cnim/eligibility. Accessed October 09, 2010. |
Covered Diagnosis Codes
For procedure codes 95965, 95966, 95967, S8035 (MEG/MSI), including but not limited to:
345.00-345.91 |
Covered Diagnosis Codes
For procedure codes 95965, 95966, 95967, S8035 (MEG/MSI), including but not limited to:
INFORMATIONAL ONLY
G40.001 | G40.009 | G40.011 | G40.019 |
G40.101 | G40.109 | G40.111 | G40.119 |
G40.201 | G40.209 | G40.211 | G40.219 |
G40.301 | G40.309 | G40.311 | G40.319 |
G40.401 | G40.409 | G40.411 | G40.419 |
G40.501 | G40.509 | G40.511 | G40.519 |
G40.801 | G40.809 | G40.811 | G40.819 |
G40.89 | G40.901 | G40.909 | G40.911 |
G40.919 |