Since January 2026, a Medicare model in six states requires prior authorization or pre-payment review for cervical fusion, vertebral augmentation, and several implanted nerve stimulators. Add 90-day global packages and monitoring rules, and a neurosurgery claim depends on paperwork finished weeks before the operating room.
Book a demoNeurosurgical revenue comes from a small number of high-value cases, so each of these rules carries weight.
The WISeR model applies to Original Medicare patients in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington for dates of service from January 15, 2026. Practices can request prior authorization for selected spine and nerve stimulator services, or the claim goes to pre-payment medical review.
Intraoperative neurophysiology monitoring (95940, 95941, and G0453) is included in the operating surgeon's global package. A different professional who performs the monitoring can report it.
Most spine and cranial procedures carry 90-day global periods. Co-surgeon, assistant-at-surgery, and multiple procedure rules change what each surgeon on a case is paid.
Neurosurgery groups often split work between the clinic, several hospitals, and an outside monitoring team.
Surgeons document the indication, imaging findings, prior conservative care, and operative details. They approve every code before submission.
Taiga drafts ICD-10 and CPT codes from operative and clinic notes, checks eligibility, scrubs and submits claims, and appeals each denial. Patient statements and balance follow-up sit with Taiga as well.
Prior authorization requests, implant and device paperwork, and coordination with the monitoring group each need a named owner before go-live.
Bring de-identified examples of a spinal fusion, a cranial case, and a stimulator implant if you perform them.
Note whether you treat Original Medicare patients in a WISeR state and which commercial plans require authorization for spine work.
Explain whether monitoring comes from an outside company, a hospital team, or a professional in your group.
Describe how often you operate with a co-surgeon or assistant and how those claims are coordinated today.
Useful for a physician-owned neurosurgery or spine practice that wants high-value surgical claims coded carefully and every denial worked to the end.
Neurosurgery is not on Taiga's published specialty list, so bring your service mix and Taiga will tell you straight whether it fits. Diagnostic EEG and nerve testing are covered on Taiga's neurology page.
No. CMS says WISeR does not change existing Original Medicare coverage or payment policies, and appeal rights stay in place. It adds a review step before payment for selected services.
Original Medicare patients treated in the six model states. Medicare Advantage and Railroad Medicare patients are not part of the model.
No. NCCI policy treats intraoperative neurophysiology monitoring as part of the operating surgeon's global package. A separate professional who performs the monitoring can bill for it.
No. Taiga works alongside the EHR you use now, and your surgeons approve each code it drafts from their operative notes.
Show Taiga your fusion, cranial, and implant volume along with recent denials. If it fits, onboarding takes about two weeks to first claim.
System guides show possible billing handoffs, not proven specialty compatibility.