Cerebral oxygenation monitoring utilizes near-infrared spectroscopy (NIRS) a non-invasive technology capable of continuously obtaining data related to cerebral blood flow and specifically hemoglobin oxygen saturation. This data is used to estimate the oxygen O2 saturation of the cerebral tissue.
Cerebral Oxygenation Monitoring using Near Infrared Spectroscopy (NIRS) is considered experimental/investigational, as published data are inadequate to prove the safety and efficacy of this procedure.
Internal Medical Policy Committee 5-19-2020 Annual Review
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.