The operative note.
Procedure, levels, approach, and that monitoring was requested and used.
IN THREE MOVEMENTS · LISTEN · PROVE · RECOVER
IONM claims aren’t general billing. We never treated them like they were.
MOVEMENT I · LISTEN
This is not a service line we added.
It is what the firm was built around, and it is most of what we do all day. Intraoperative neuromonitoring is a live reading: somatosensory potentials on one line, motor potentials on another, baselines set at the start of the case and every trend read against them while the surgeon works.
That is why the billing is unlike anything else. The record has to show the service was continuous, interpreted live, and clinically meaningful, and the monitoring code depends on where the professional was and how many rooms they covered. Those distinctions are where most of the lost revenue in this specialty lives.
Twenty-five years in diagnostic medicine taught us what the clinical work actually is, what it costs to do properly, and what the record is supposed to say when it’s done right. We bill what happened.
The sensory lines
Somatosensory evoked potentials (95925-95927): upper limbs, lower limbs, or trunk and head. The base studies are what make the monitoring payable. Omit them and the monitoring code has nothing to attach to.
The motor lines
Central motor evoked potentials by transcranial stimulation (95928-95929). Frequently denied as investigational by plan policy. Winnable, but only with the plan language in hand.
Who was listening, and from where
One-on-one attendance in the room (95940) bills per 15 minutes. Remote oversight (95941) bills per hour, and Medicare requires G0453 instead, per 15 minutes. Same service, different payer, different math entirely.
MOVEMENT II · PROVE
A clean IONM claim is assembled, not submitted.
The documentation and the codes have to agree with each other before the claim goes out. The operative note, the technologist’s log, the oversight physician’s report, the baselines and any alert events: reconciling them after a denial is how good cases die, so we reconcile them first.
When a piece is missing, we go get it. We don’t send the claim and hope. It is slower on day one and dramatically faster to payment.
The technologist’s log.
Setup, modalities run, start and stop times, and every alert with the response to it.
The oversight physician’s report.
Signed, timed, and consistent with the monitoring code being billed.
Baselines and trend data.
Evidence the service was continuous, interpreted live, and clinically meaningful.
Attendance and coverage record.
Who was in the room, who was remote, and how many cases they held at once.
Eligibility, benefits, and plan type.
Self-funded or fully insured, and whether federal protections apply. Checked before the claim, not after.
The work in the operating room is only half of it.
While the surgeon works,
someone is listening to every signal.
The other half is proving it: in the right codes, with the right documentation, inside the payer’s deadlines.
MOVEMENT III · RECOVER
When the payer underpays, a clock starts.
The payer’s default answer is no. Not medically necessary. Not separately payable. Bundled into the surgeon’s fee. Duplicative of another provider. Those are four different denials that need four different appeals, and a template letter answers none of them. We answer every denial on its own terms, with the clinical record behind it; no template letters, no giving up at level one.
Since 2022, out-of-network monitoring at an in-network facility can’t be balance billed to the patient. The No Surprises Act replaced that balance with a federal dispute process: a calendar, an evidence package, and a single best offer. It is winnable, and we run it as routine work, not as an escalation.
DENIALS
APPEALS
OPEN NEGOTIATION
FEDERAL IDR
Open negotiation
A formal notice, a supported number, and an actual negotiation. Settling here is faster and avoids arbitration fees entirely, so this is where we push hardest.
Federal IDR
Initiation is a narrow window measured in business days. This is the single most common place practices lose otherwise winnable money: not by losing, but by being late.
The offer package
Each side submits one number with supporting evidence: complexity of the case, training required, market rates, prior contracted history. The arbiter picks one offer outright, and the losing side carries the fee. An offer without a story behind it loses to one that has one.
The only numbers worth putting on a website are the ones we can back up.
IDR RECORD
127 · IDR cases initiated in 2025
81% · Resolved in our clients’ favor
64% · Settled before arbitration
OUTCOMES
94% · Average net collection rate · Across IONM and AEEG clients, the trailing 12 months
78% · Of denials overturned on appeal · First- and second-level appeals combined
38 days · Average days in A/R · Measured from date of service
Timeframes and eligibility under the federal dispute process are set by regulation and have been subject to ongoing rulemaking and litigation. We track current requirements per claim and per plan; nothing on this page should be relied on as legal advice.
Send us thirty denied claims. We’ll tell you what they’re actually worth.
No cost, no commitment, no contract to sign first. We’ll review them, tell you what went wrong, and show you what we’d do differently. If the answer is “nothing”, we’ll tell you that too.
Or email lisa@hnpcs.net and reach her directly.