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Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 9/1/26
Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
Aug 26, 2026
Summary
Ambetter from WellCare of New Jersey is implementing new billing and payment criteria for Intraoperative Neurophysiologic Monitoring (IONM) services effective September 1, 2026. Only CMS-recognized payable code 95940 with modifier G0453 will be covered; code 95941 is non-covered. Billing must comply with strict criteria including exclusive patient attention, maximum 4 units per 60 minutes, and appropriate place of service codes (19, 21, 22, or 24). IONM cannot be billed by surgeons or anesthesia providers as it is included in the global surgical package.
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What to do
by Aug 31, 2026 · 4 steps
01Billing team must update billing software and claims submission protocols to (1) accept only CPT code 95940 with modifier G0453 for IONM services on Ambetter Marketplace plans; (2) deny or reject claims for CPT code 95941 as non-covered; (3) implement system edits to enforce maximum 4 units per 60-minute period; (4) require validation that total units billed do not exceed total monitoring time available; (5) add claim-level edits to prevent IONM billing by surgeon or anesthesia provider; (6) enforce place of service requirements (codes 19, 21, 22, or 24 only).
02Update provider encounter forms and billing instructions to clarify that IONM is included in the global surgical package and should not be billed separately by surgical/anesthesia providers.
03Providers and billing staff must be educated on these changes.
04Claims submitted after September 1, 2026 that fail to meet these criteria will be denied.
Codes mentioned
95940G045395941
Original notice
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 9/1/26
ambetterhealth.com · Always check the source before changing claims.
Related changes
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