Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

PAP 516

Intraoperative Monitoring


Provider Administrative Policy

Section
Physician
Policy Date
May 2012
Status/Date
Revised/January 2013
Provider Type(s)
Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Intraoperative Monitoring

Intraoperative monitoring (IOM) is used to identify systemic compromises in a patient during a surgical procedure. The intent of the monitoring is to alert the surgeon of possible threats to the well-being of the patient so the surgeon may alter the course of the procedure in order to avoid permanent damage.

Blue Cross of Idaho will only consider allowing reimbursement for IOM when a licensed physician or other provider acting within the scope of his license performs the monitoring while in constant attendance in the operating room throughout the procedure. The provider performing IOM must be someone other than the operating surgeon or anesthesiologist. Additionally, the provider performing IOM must be recognized as a Covered Provider by BCI, as defined in PAP247 and able to bill independently under their own NPI. The surgeon (or surgical assist) performing the surgery or the anesthesiologist performing the surgical anesthesia are not eligible for additional reimbursement for IOM. We will not allow reimbursement for remote or on-line IOM.

CPT code 95940 is an add on code and can only be reported with the auditory evoked potential, EEG, EMG, nerve conduction study, evoked potential or the reflex test it is used with.

IOM is not indicated as medically necessary for all procedures. Blue Cross of Idaho may consider IOM services medically necessary during spinal, intracranial, or vascular procedures. However, these monitoring services are not clinically indicated for procedures on the parotid gland, thyroid or sinus. Therefore, CPT 95940 is not separately payable when billed by the surgeon performing any of the following procedures:

CPT 42300 – 42699
CPT 60210 – 60300


Policy History

Date Action Reason
January 2013 Revised Updated to reflect 2013 CPT codes
November 2012 Revised Included language for add on procedure and other covered providers

Search for Policies

Policy Feedback