title: Changes to CMS reimbursement rules for intraoperative neurophysiological monitoring: implications for telemedicine.
abstract: Intraoperative neurophysiological monitoring (IONM) is used as an adjunct for surgeries that pose risk to nervous system structures. IONM is performed by a technologist in the operating room and is overseen by a highly trained fellowship-trained physician clinical neurophysiologist. Telemedicine has allowed the professional oversight component to be done remotely, with reimbursement for multiple simultaneous cases. Recent changes to Current Procedure Terminology coding and Medicare reimbursement policies provide options only for exclusive 1:1 technologist:oversight physician billing. This policy change may create profound repercussions in the practice of telemedicine by actively discouraging the leveraging of highly specialized and scarce expertise through on-site physician extenders.
authors: Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington , Seattle, Washington.
authors: John P
authors: JP
authors: Ney
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000191:economics*; D016134:Organizational Policy; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D017216:Telemedicine; D014481:United States
references: Muscle Nerve. 2000 Sep;23(9):1443-4
references: 10951451
references: Neurology. 2012 Feb 21;78(8):585-9
references: 22351796
references: Fed Regist. 2012 Nov 16;77(222):68891-9373
references: 23155552
references: Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S37-46
references: 20407350
references: Arch Surg. 2010 Dec;145(12):1201-8
references: 21173295
references: Clin Neurophysiol. 2012 Sep;123(9):1705-7
references: 22386320
references: Electroencephalogr Clin Neurophysiol. 1995 Jan;96(1):6-11
references: 7530190