ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 6/15/26
Ambetter·AL · Neurosurgery, Orthopedics, General Surgery +1 more·Claims & Billing
Effective date
Jun 15, 2026
We identified it
Aug 26, 2026
Summary
Ambetter of Alabama is implementing new coverage and billing requirements for Intraoperative Neurophysiologic Monitoring (IONM) services effective June 15, 2026. Only CMS-recognized payable code 95940 with modifier G0453 is covered for Marketplace plans; code 95941 is non-covered. Billing must comply with strict criteria including exclusive patient attention, maximum 4 units per 60-minute period, appropriate place of service codes, and cannot be billed by surgeon or anesthesia provider.
Action Required
By June 15, 2026: Billing team must update claims submission system to ONLY accept CPT 95940 with modifier G0453 for Ambetter of Alabama Marketplace plans and deny claims for CPT 95941. Update billing edits to enforce: (1) maximum 4 units per 60-minute monitoring period, (2) total units do not exceed available monitoring time, (3) Place of Service must be 19, 21, 22, or 24, and (4) service cannot be billed if submitted by surgeon or anesthesia provider. Train providers and billing staff that IONM cannot be billed as part of global surgical package. Update fee schedules and charge capture systems. Implement system logic to prevent claims submission for 95941 and flag any 95940 claims lacking required modifiers or meeting non-compliant criteria. Failure to comply will result in claim denials from Ambetter of Alabama.