Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 6/15/26

By June 15, 2026: Billing team must implement the following changes in the billing system: (1) Update claim scrubbing rules to deny or reject all claims for CPT 95941 for Ambetter Marketplace plans; (2) Configure system to accept only CPT 95940 and HCPCS G0453 for IONM services on Marketplace plans; (3) Add validation logic to enforce maximum 4 units per 60-minute period and prevent total units from exceeding monitoring time; (4) Add Place of Service validation requiring codes 19, 21, 22, or 24 for IONM claims; (5) Add billing rule to deny claims when IONM is billed by surgeon or anesthesia provider (verify provider type before processing); (6) Update provider communication and encounter templates to clarify that IONM services require exclusive, undivided attention to one patient and must be billed by appropriate personnel (not surgical/anesthesia team). Failure to implement these changes will result in claim denials and payment integrity issues with Ambetter from Peach State Health Plan.