Intraoperative somatosensory evoked potentials (SEPs, SSEPs) performed either alone, or in combination with motor evoked potentials (MEPs).Combined use of intraoperative EMG monitoring of facial nerve and intraoperative monitoring of somato-sensory evoked potentials is considered not medically necessary.Resection of spinal cord tumors (e.g., cauda equina tumor, nerve root tumor including schwannoma, and neurofibroma, and sacral chordoma).Resection of skull base tumors including posterior fossa tumor (cranial nerve monitoring).Location of the hypoglossal nerve during implantation of an Inspire hypoglossal nerve stimulator.Excision of branchial cleft anomalies (cysts, fistulae, or sinuses).Of any of the following cranial nerves for surgical excision of neuromas of these cranial nerves:.During selective dorsal rhizotomy when selection criteria for the procedure set in CPB 0362 - Spasticity Management are met.Vestibular neurectomy for Meniere's disease or.Surgical excision of neuromas of the facial nerve or. Surgery for cholesteatoma, including mastoidotomy or mastoidectomy or.Surgery for acoustic neuroma, congenital auricular lesions, or cranial base lesions or.Microvascular decompression of the facial nerve for hemifacial spasm or.During canalplasty/external canal reconstruction or.Facial nerve for members undergoing any of the following intracranial neuro-otological surgeries:.Intraoperative electromyographic (EMG) monitoring for the following indications (unless otherwise specified):.This Clinical Policy Bulletin addresses intraoperative neurophysiological monitoring.Īetna considers intraoperative neurophysiological monitoring medically necessary (unless otherwise specified) for the following indications when criteria are met: Number: 0697 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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