𝗧𝗵𝗲 𝗦𝗵𝗿𝗶𝗻𝗸𝗶𝗻𝗴 𝗥𝗲𝗶𝗺𝗯𝘂𝗿𝘀𝗲𝗺𝗲𝗻𝘁 𝗟𝗮𝗻𝗱𝘀𝗰𝗮𝗽𝗲 𝗶𝗻 𝗡𝗲𝘂𝗿𝗼𝗺𝗼𝗻𝗶𝘁𝗼𝗿𝗶𝗻𝗴 (IONM)

Intraoperative neuromonitoring (IONM) is one of the most powerful safeguards we have in surgery. It helps prevent devastating neurological injuries, gives surgeons real-time feedback, and provides patients with peace of mind. But behind the operating room doors, 𝗮 𝗳𝗶𝗻𝗮𝗻𝗰𝗶𝗮𝗹 𝗰𝗿𝗶𝘀𝗶𝘀 𝗵𝗮𝘀 𝗯𝗲𝗲𝗻 𝗾𝘂𝗶𝗲𝘁𝗹𝘆 𝘂𝗻𝗳𝗼𝗹𝗱𝗶𝗻𝗴.

Last week, I hosted a webinar on IONM billing. (See the recording here: https://youtu.be/TnGluPVe-8w) The discussion made one thing clear: 𝗶𝗳 𝘄𝗲 𝗱𝗼𝗻'𝘁 𝘀𝘁𝗮𝗿𝘁 𝘁𝗮𝗹𝗸𝗶𝗻𝗴 𝗼𝗽𝗲𝗻𝗹𝘆 𝗮𝗯𝗼𝘂𝘁 𝗱𝗲𝗰𝗹𝗶𝗻𝗶𝗻𝗴 𝗿𝗲𝗶𝗺𝗯𝘂𝗿𝘀𝗲𝗺𝗲𝗻𝘁𝘀 𝗮𝗻𝗱 𝗿𝗶𝘀𝗶𝗻𝗴 𝗰𝗼𝘀𝘁𝘀, 𝗼𝘂𝗿 𝗳𝗶𝗲𝗹𝗱 𝘄𝗶𝗹𝗹 𝘀𝘂𝗳𝗳𝗲𝗿. This blog is a continuation of that conversation — and a call to action for every technologist, physician, and industry partner to advocate for change.

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Average OON (Out of network) insurance reimbursement vs average operating cost for neuromonitoring groups (2014-2024)

𝗔 𝗗𝗲𝗰𝗮𝗱𝗲 𝗼𝗳 𝗗𝗲𝗰𝗹𝗶𝗻𝗶𝗻𝗴 𝗣𝗮𝘆𝗺𝗲𝗻𝘁𝘀

In 2014, many IONM providers could expect 𝗼𝘃𝗲𝗿 $𝟱,𝟬𝟬𝟬 in reimbursement for a complex spine case. Today, the same case net only 𝗼𝗻𝗹𝘆 $𝟭,𝟱𝟬𝟬–$𝟮,𝟬𝟬𝟬 on average.

𝗪𝗵𝘆 𝘁𝗵𝗲 𝗱𝗿𝗼𝗽?

• Private insurers tightened policies after years of high out-of-network charges, paying less and less

• Medicare pays less than $30 most places per 15-minute unit for continuous monitoring (CPT 95940/G0453)

• Hospitals negotiate contracts that leave little room for margin

𝗧𝗵𝗲 𝗿𝗲𝘀𝘂𝗹𝘁: Reimbursements for neuromonitoring services have fallen by 𝟱𝟬–𝟴𝟬% since 2014, depending on the payer and case type.

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Neuromonitoring Operating Cost Breakdown (2014-2024)

𝗧𝗵𝗲 𝗥𝗶𝘀𝗶𝗻𝗴 𝗖𝗼𝘀𝘁 𝗼𝗳 𝗖𝗮𝗿𝗲

At the same time, the cost of doing business has gone up across the board:

• Wages & Benefits: Inflation increased living costs by nearly 30% over the decade

• Travel: Gas, airfare, and lodging costs surged in recent years

• Insurance: Liability and business coverage premiums continue rising

• Supplies & Compliance: Electrodes, equipment, IT security, accreditation costs

On average, per-case operating costs have increased from around $2,000 in 2014 to 𝗼𝘃𝗲𝗿 $𝟯,𝟲𝟬𝟬 in 2024.

𝗧𝗵𝗲 𝗙𝗶𝗻𝗮𝗻𝗰𝗶𝗮𝗹 𝗦𝗾𝘂𝗲𝗲𝘇𝗲

Put simply: 𝗰𝗼𝗺𝗽𝗮𝗻𝗶𝗲𝘀 𝗮𝗿𝗲 𝗻𝗼𝘄 𝗴𝗲𝘁𝘁𝗶𝗻𝗴 𝗽𝗮𝗶𝗱 𝗹𝗲𝘀𝘀 𝘄𝗵𝗶𝗹𝗲 𝘀𝗽𝗲𝗻𝗱𝗶𝗻𝗴 𝗺𝗼𝗿𝗲 to provide the same service.

This financial squeeze has eroded margins to the point where many providers are breaking even — or even losing money — on certain cases. Independent groups have been hit the hardest, with some consolidating, selling, or closing altogether.

𝗪𝗵𝗲𝗿𝗲 𝗪𝗲 𝗠𝗶𝗴𝗵𝘁 𝗙𝗶𝗻𝗱 𝗥𝗲𝗹𝗶𝗲𝗳

While the squeeze is real, there are emerging advancements that may help our industry adapt:

𝟭. Automation for Routine Cases

Some lumbar procedures are almost guaranteed to be denied reimbursement for physician oversight. Automated systems for EMG and SSEPs are becoming more capable, potentially allowing lower-risk cases to be covered more efficiently.

𝟮. AI Integration for Techs

Artificial intelligence is starting to make its way into neuromonitoring platforms. Done right, AI could support technologists with real-time alerts and fail-safes - not replacing people, but supporting them.

𝟯. Independent Dispute Resolution (IDR) & Arbitration

The No Surprises Act introduced IDR as a pathway for providers to contest unfairly low payments. Used responsibly, it can be a valuable tool to level the playing field.

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𝗪𝗵𝘆 𝗧𝗵𝗶𝘀 𝗠𝗮𝘁𝘁𝗲𝗿𝘀 𝗳𝗼𝗿 𝘁𝗵𝗲 𝗪𝗼𝗿𝗸𝗳𝗼𝗿𝗰𝗲

For technologists and monitoring physicians, the financial squeeze shows up as:

• Wage growth that doesn't keep up with inflation

• Increased caseloads to "make up" for lost revenue

• Burnout from travel and staffing shortages

• Limited investment in new equipment or training

𝗜𝗳 𝗻𝗼𝘁𝗵𝗶𝗻𝗴 𝗰𝗵𝗮𝗻𝗴𝗲𝘀, the long-term risk is fewer independent providers, reduced patient access, and compromised quality of care.

𝗪𝗵𝗮𝘁 𝗪𝗲 𝗖𝗮𝗻 𝗗𝗼

This isn't a call to despair - 𝗶𝘁'𝘀 𝗮 𝗰𝗮𝗹𝗹 𝘁𝗼 𝗮𝗰𝘁𝗶𝗼𝗻. Here's how we can respond:

𝟭. Educate Yourself: Know the numbers. Understand how much insurers and Medicare actually pay

𝟮. Share the Reality: Bring surgeons and hospital partners into the conversation

𝟯. Advocate Together: Join groups like ASNM and ASET - recruit others to join in the fight

𝟰. Stay United: The more we work together, the stronger our advocacy becomes

𝗖𝗹𝗼𝘀𝗶𝗻𝗴 𝗧𝗵𝗼𝘂𝗴𝗵𝘁

𝗡𝗲𝘂𝗿𝗼𝗺𝗼𝗻𝗶𝘁𝗼𝗿𝗶𝗻𝗴 𝘀𝗮𝘃𝗲𝘀 𝗹𝗶𝘃𝗲𝘀. It can prevent injury, paralysis, or worse. It protects patients and gives surgeons confidence. 𝗜𝘁 𝗶𝘀 𝘁𝗼𝗼 𝘃𝗮𝗹𝘂𝗮𝗯𝗹𝗲 𝘁𝗼 𝗯𝗲 𝘂𝗻𝗱𝗲𝗿𝗺𝗶𝗻𝗲𝗱 𝗯𝘆 𝘂𝗻𝘀𝘂𝘀𝘁𝗮𝗶𝗻𝗮𝗯𝗹𝗲 𝗲𝗰𝗼𝗻𝗼𝗺𝗶𝗰𝘀.

By educating ourselves, embracing new tools, and uniting as a community, we can push for a future where neuromonitoring is not just clinically indispensable - 𝗯𝘂𝘁 𝗳𝗶𝗻𝗮𝗻𝗰𝗶𝗮𝗹𝗹𝘆 𝘀𝘂𝘀𝘁𝗮𝗶𝗻𝗮𝗯𝗹𝗲 𝘁𝗼𝗼.

Logan McKnight