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Health NetCommercial · Billing Codes · Reimbursement · CA · Neurosurgery, Orthopedics, Cardiothoracic Surgery +2 moreHigh impact

26-773 IONM Billing Requirements Change, Effective August 14, 2026

Effective date
Aug 14, 2026
Identified
Jun 20, 2026

Summary

Health Net is implementing new IONM billing requirements effective August 14, 2026, that align with CMS guidelines. Only specific CMS-recognized codes will be reimbursed, with strict unit limits and monitoring requirements that must be met to avoid claim denials.

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What to do

Action · 5 steps
01Before August 14, 2026: Billing team must update system to only allow CPT 95940 and HCPCS G0453 for covered IONM services, block CPT 95941 as non-covered.
02Configure edits to limit billing to maximum 4 units per 60-minute period and ensure total units don't exceed monitoring time.
03Verify Place of Service codes POS 19, 21, 22, or 24 are used.
04Prevent surgeons and anesthesia providers from billing these codes separately.
05Claims not meeting these requirements will be denied.

Codes mentioned

9594095941G0453

Original notice

26-773 IONM Billing Requirements Change, Effective August 14, 2026
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Health Net policiesCA policy changesNeurosurgeryOrthopedicsCardiothoracic SurgeryGeneral SurgeryAnesthesiologyCode 95940Code 95941Code G0453

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