Coverage of Intraoperative Neurophysiological Monitoring

Please keep in mind that Harvard Pilgrim considers intraoperative neurophysiological monitoring (INM) with an FDA approved technique/device as medically necessary for commercial members when ordered by the operating surgeon and performed during covered procedures (please refer to Harvard Pilgrim’s Intraoperative Neurophysiological Monitoring Medical Policy for a list of covered procedures and exclusions).

INM refers to various methods of monitoring the strength and structure of neural pathways during high-risk surgeries. This technology is intended to identify abnormalities and prevent complications, and allow for swift intervention to avoid permanent nervous system damage. Some high-risk patients may be candidates fora surgical procedure only if monitoring is available, and it is critical that INM is performed with undivided attention to one patient at a time. INM services require supervision and interpretation by a provider who is present at the operating site or from a remote location using continuous monitoring technologies.

When billing, please note that INM should not be reported by the physician performing the operative procedure since INM is included in the global package for the surgery. Time billed for INM should only be submitted for the time dedicated to monitoring, and the member’s medical record should document the time spent in monitoring in correlation to the surgery performed. Billed time should not exceed the amount of time the member is under anesthesia. You can find contracted INM providers in Harvard Pilgrim’s online Provider Directory under the neurology specialty.

When ordering INM services for surgical candidates, operating surgeons should be aware that a large number of INM companies are not contracted with Harvard Pilgrim. Orders from operating surgeons need to detail all modalities that are requested during the procedure. Caution should be utilized when selecting an INM provider as services performed by non-contracted entities typically result in substantially higher costs to your patient.

Harvard Pilgrim maintains the right to audit the services provided to our members, regardless of the participation status of the provider, and all documentation must be available to Harvard Pilgrim upon request. Failure to produce the requested records may result in claim denial for ordered or arranged services.

For more information, please refer to the Intraoperative Neurophysiological Monitoring Medical Policy.

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