CPT for ENT: Intraoperative Neurophysiology Testing

CPT for ENT: Intraoperative Neurophysiology Testing

Q: What is Intraoperative Neurophysiology Testing and can I bill for it?

A: This is an "add-on" service, formerly reported with CPT 95920 which has been deleted and replaced with 2 new codes, CPT +95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedures); and +95941 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour.  In the 2013 final Medicare Physician Fee Schedule, however, The Centers for Medicare and Medicaid Services (CMS) elected not to accept the CPT Editorial Panel’s addition of CPT +95941, and instead, created a G code to report monitoring which occurs outside the operating room.  Providers should therefore, report G0453 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) for monitoring occurring outside the operating room.

Physicians use these CPT codes when performing nerve monitoring during complex surgical procedures involving cranial nerves. Another physician (usually a neurologist or physiatrist), or an electrodiagnostic technologist, prepares the patient prior to surgery by attaching fine wires and electrodes on designated areas, such as the face or neck, during a case of facial nerve monitoring. For recurrent nerve monitoring, the electrodes are integrated into the endotracheal tube. These electrodes are connected to electrodiagnostic equipment that monitors specific nerves either through automated monitoring (e.g., an audible alarm), or by the clinician’s interpretation of the monitoring device's output.

The American Medical Association’s Current Procedural Terminology (CPT®) does not limit CPT codes to any particular specialty. However, the CPT® introductory language and AMA coding guidance is clear that in order to bill these codes (+95940, +95941, or G0453) the service must be performed by a monitoring professional who is SOLELY DEDICATED to performing the intraoperative neurophysiologic monitoring and is available to intervene at all times during the service as necessary.  The monitoring professional may not provide any other clinical activities during the same period of time. In the event the monitoring is performed by the surgeon or anesthesiologist, the professional services are INCLUDED in the primary service code(s) and SHOULD NOT BE REPORTED SEPARATELY.  In addition, these codes should not be reported for automated monitoring devices that do not require continuous attendance by a professional qualified to interpret the testing and monitoring.  

These codes, as with all add-ons, are not billable as standalone codes and are linked to the appropriate neurophysiologic monitoring code. For example, if facial nerve monitoring is performed during a parotidectomy, link CPT code +95940, +95941, or G0453 with the appropriate EMG CPT code (95867 - Needle electromyography; cranial nerve supplied muscle(s), unilateral) instead of with the parotidectomy CPT code. If the physician performs only the interpretation and does not own the equipment, he or she should append modifier -26 (professional component) to the code. The provider performing the monitoring must report both the intra-operative findings and record his or her precise level of involvement to obtain reimbursement. It is best to use CPT terminology in the dictation whenever possible. The physician who performs the nerve monitoring should have appropriate credentials to justify reimbursement. In addition, providers should note that there is not currently a code for reporting the use of surface electrode EMG monitoring performed for recurrent laryngeal nerve monitoring during thyroid surgery.

Members should also be aware that many carriers consider monitoring with an automated device integral to the surgery performed and will not reimburse for these services separately. Therefore, providers should familiarize themselves with their local Medicare Administrative Contractor (MAC) or private insurer’s medical policies and coding guidelines for these CPT codes prior to reporting these services. Ultimately, it is the discretion of the surgeon to determine the mode and administration of these tests.

Reviewed May 2007
Revised June 2009
Revised February 2013

Important Disclaimer Notice (Updated 8/7/14)

CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.