ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 7/1/26
Ambetter·OH · Neurosurgery, Orthopedics, Cardiothoracic Surgery +2 more·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Aug 26, 2026
Summary
Effective July 1, 2026, Ambetter from Buckeye Health Plan is restricting IONM (Intraoperative Neurophysiologic Monitoring) reimbursement to only CMS-recognized payable codes with strict billing criteria. Code 95941 is now non-covered, while 95940 with modifier G0453 remains covered only when billed by monitoring specialists (not surgeons/anesthesia) with exclusive patient attention, maximum 4 units per 60 minutes, and appropriate Place of Service codes.
Action Required
By June 30, 2026: Billing team must (1) Update billing software to REJECT claims for CPT 95941 as non-covered for Ambetter Marketplace plans; (2) Configure system to require CPT 95940 with modifier G0453 only when billed by qualified monitoring personnel (not surgeon or anesthesia provider); (3) Implement unit limitation rules to block claims exceeding 4 units per 60-minute period; (4) Validate Place of Service codes 19, 21, 22, or 24 on all IONM claims; (5) Update provider education materials and encounter templates to clarify that IONM cannot be billed by surgical or anesthesia teams. Train all billing and clinical staff on these requirements. Claims submitted after 7/1/26 not meeting these criteria will be denied by Ambetter.