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What is IONM?

IONM stands for Intraoperative Neurophysiological Monitoring. IONM is a tool used by surgeons to identify, limit, and prevent injury to a patient's nervous system during surgery. By stimulating your nerves and recording the responses throughout your procedure, IONM tests can alert the surgical team to evolving injury so that corrective action can be taken immediately. These techniques were first developed by Audiologists and Neuroscientists in the 1970's in order to protect spinal cord function during pediatric scoliosis correction, as well as to protect auditory function during acoustic neuroma surgery. Since then, various additional tests and applications have been identified which allow a wide range of procedures to be monitored effectively.

When Would My Surgeon Use IONM?

Although IONM was used for a limited number of surgeries in the past, the use of IONM today is so widespread that it is becoming a standard of care for many surgeries that place your nervous system at risk. Your surgeon may request IONM for a variety of reasons. Here are some of the most common procedures utilizing IONM:

  • Lumbar Discectomy and Fusion

  • Cervical Discectomy and Fusion

  • Thoracic FUsion

  • Spinal Deformity Correction (such as scoliosis or kyphosis)

  • Chiari Decompression

  • Brain Tumor Resection

  • Spinal Tumor Resection

  • Cerebral Aneurysm Clipping or Coiling

  • Peripheral Nerve Tumor Resection

  • Carotid Endarterectomy

  • Thyroidectomy

Are There Any Risks?

Intraoperative Neuromonitoring is a noninvasive procedure with minimal risks while affording significant protection for your nervous system. These risks vary depending on the specific tests used to monitor your surgery. Your Peak Neurophysiologist will see you in the preoperative holding area to discuss your individually tailored IONM plan and answer any questions or concerns you may have prior to your surgery.

What Does It Cost?

As with anesthesia and other ancillary services provided during your surgery, IONM services are billed separately from the surgical procedure. The neurologist or other appropriately-credentialed IONM professional involved in your procedure may send your insurance provider a bill for the IONM services rendered. The amount billed will depend on many factors, such as the length of your procedure and type of monitoring performed.


These claims will be filed under the provider’s associated professional entity (Intraoperative Neurology Services PC or others). You will likely receive an “Explanation of Benefits” (EOB) from your insurance provider detailing the allowed amounts, and which may include a line labeled “Total Patient Responsibility”. PLEASE BE ASSURED THAT THIS IS NOT A BILL. We will NEVER bill you for any amount of IONM services in excess of the allowed amount determined by your insurer. Your out-of-pocket cost for IONM services, therefore, will depend only on the deductible and co-insurance amounts (if any) specific to your plan.


*PLEASE NOTE that if your insurance provider sends an IONM reimbursement check directly to you, this must be forwarded immediately to our billing department. If you have any questions about EOBs, IONM charges, or a bill that you may have received, please do not hesitate to contact our billing specialists, Black Rock Medical Billing, at 1-412-262-0720 or

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