ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 6/15/26
Ambetter·OK · Neurosurgery, Orthopedics, General Surgery +1 more·Claims & Billing
Effective date
Jun 15, 2026
We identified it
Aug 26, 2026
Summary
Effective June 15, 2026, Ambetter of Oklahoma is implementing new billing and payment requirements for Intraoperative Neurophysiologic Monitoring (IONM) services on Marketplace plans. Only CMS-recognized payable codes (95940, G0453) are eligible for reimbursement; code 95941 is now non-covered. Services must meet five specific criteria including exclusive patient attention, maximum 4 units per 60 minutes, and proper Place of Service coding, with IONM services excluded from surgeon/anesthesia billing.
Action Required
By June 15, 2026: Billing team must (1) Update billing software to deny claims for CPT 95941 on all Marketplace plans; (2) Configure system to accept only CPT 95940 and HCPCS G0453 for IONM services; (3) Implement automated edits to enforce maximum 4 units per 60-minute period and validate that total units do not exceed monitoring time available; (4) Add claim validation rules to reject IONM claims when billed by surgeon or anesthesia provider; (5) Ensure Place of Service codes 19, 21, 22, or 24 are required on all IONM claims; (6) Update provider communication and billing guides to reflect covered/non-covered code changes; (7) Audit existing outstanding claims billed with 95941 and resubmit or deny as appropriate. Providers must be notified immediately. Failure to implement will result in claim denials and revenue loss.