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Intraoperative Neurophysiologic Monitoring

Intraoperative neurophysiologic monitoring, which includes somatosensory-evoked potentials, motor-evoked potentials using transcranial electrical stimulation, brainstem auditory-evoked potentials, electromyography of cranial nerves, electroencephalography, and electrocorticography, may be considered medically necessary during spinal, intracranial, or vascular procedures.
Intraoperative neurophysiologic monitoring of the recurrent laryngeal nerve may be considered medically necessary in patients undergoing:

high-risk thyroid or parathyroid surgery, including:

total thyroidectomy

repeat thyroid or parathyroid surgery

surgery for cancer


retrosternal or giant goiter


anterior cervical spine surgery associated with any of the following increased risk situations:

prior anterior cervical surgery, particularly revision anterior cervical discectomy and fusion, revision surgery through a scarred surgical field, reoperation for pseudarthrosis, or revision for failed fusion

multilevel anterior cervical discectomy and fusion

preexisting recurrent laryngeal nerve pathology, when there is residual function of the recurrent laryngeal nerve.

Intraoperative neurophysiologic monitoring of the recurrent laryngeal nerve during anterior cervical spine surgery not meeting the criteria above or during esophageal surgeries is considered investigational.

Intraoperative monitoring of visual-evoked potentials is considered investigational.

Due to the lack of monitors approved by the U.S. Food and Drug Administration, intraoperative monitoring of motor-evoked potentials using transcranial magnetic stimulation is considered investigational.

Intraoperative electromyography and nerve conduction velocity monitoring during surgery on the peripheral nerves is considered investigational.

Note: These policy statements refer only to use of these techniques as part of intraoperative monitoring. Other clinical applications of these techniques, such as visual-evoked potentials and electromyography, are not considered in this policy.

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