ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 8/1/26
Ambetter·MI · Neurosurgery, Orthopedics, Cardiothoracic Surgery +2 more·Claims & Billing
Effective date
Aug 1, 2026
We identified it
Aug 26, 2026
Summary
Effective August 1, 2026, Ambetter from Meridian will only reimburse IONM services billed with CMS-recognized payable codes (95940, G0453) for Marketplace plans. Code 95941 is now non-covered. Billing must comply with strict CMS requirements: exclusive patient attention, maximum 4 units per 60 minutes, appropriate place of service codes, and services cannot be billed by surgeon or anesthesia provider.
Action Required
By July 31, 2026: Billing team must update billing system to reject or deny claims for IONM code 95941 for all Ambetter from Meridian Marketplace members. Verify that only codes 95940 and G0453 are submitted for IONM services. Configure system edits to enforce: (1) maximum 4 units per 60-minute period, (2) place of service codes limited to 19, 21, 22, or 24, and (3) prevent billing by surgeon or anesthesia provider. Update provider contracts and billing instructions to clarify that IONM services billed outside CMS guidelines will be denied. Train billing staff and providers on new restrictions. Failure to comply will result in claim denials and potential compliance issues.