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Participation with Payers Policy

Impulse Monitoring, Inc. (“Impulse“) provides intra-operative neurophysiologic monitoring (“IONM“) services. IONM technical services are provided by on-site technologists employed by Impulse, supported by physicians who provide physician monitoring services in real time via online connection. IONM services are provided under a contractual arrangement between Impulse and the hospital. It is the responsibility of the surgeon to let the patient know if the surgeon is requesting IONM for the surgery.

This policy is intended to be a source of information for hospitals, surgeons, practice administrators and insurance providers and is publicly available on the Impulse website at

Network Participation
Our physicians have limited in network participation: they participate with Medicare and with certain other payer networks. Several also participate with Blue Cross/Blue Shield. Depending on the patient's insurance plan, this means that the patient may be receiving IONM services from an out of network provider.

Why is the physician likely to be out of network?
Why is the physician likely to be out of network? IONM monitoring physicians provide a specialty service to more than 150 healthcare facilities in 27 states nationwide. It is not possible or practical for network contracts to be negotiated with all the payers that may be accepted by the different facilities.

What steps should the surgeon's office take?

  • Notify the patient: Impulse provides surgeons with information for them to give to their patient's about IONM.
  • Check with the insurance provider: Check with the carrier to find out if pre-authorization is required for a referral to an out of network provider.

Billing Process
After surgery, the patient will receive a letter from Impulse explaining the billing process.

The charges for the monitoring services are billed directly to the insurance provider (including Medicare). It takes approximately thirty days for the claim to be processed, but may take longer. After the insurance company notifies us of the amount of the patient's co-pay, co-insurance and deductible, the patient will receive a statement for the amount owed. Note that physician bills may come from one of four practice groups: American Neuromonitoring Associates, P.C., Midwest Neuromonitoring Associates, P.C., Pacific Neuromonitoring Associates, Inc. and North Pacific Neuromonitoring Associates, P.C.

Payer Medical Policies
Claims for IONM services are reported in accordance with AMA/CPT guidelines and practice billing policies – a copy of which is available on request. Medicare and other in network claims are reported subject to applicable payer policy and AMA/CPT guidelines, accompanied by additional disclosure if necessary.