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Intraoperative Neurophysiology Monitoring Performed in Addition to Evoked Potential Tests for Texas Medicaid

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective September 1, 2021, for dates of service on or after January 1, 2021, intraoperative neurophysiology monitoring (procedure codes 95940 and 95941) can be reimbursed when submitted with evoked potential test procedure code 92653.

Refer to the current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.27.3, “Evoked Potential Testing,” for a list of additional procedure codes that must be billed in conjunction with procedure codes 95940 and 95941.

Claims submitted before September 1, 2021, that included procedure code 92653 with procedure codes 95940 and 95941, may have been processed incorrectly and will be reprocessed. Affected claims may result in an additional payment, which will be reflected on future Remittance and Status Reports.

For more information, call the TMHP Contact Center at 800-925-9126.