ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 7/1/26
Ambetter·PA · General Surgery, Cardiothoracic Surgery, Neurosurgery +2 more·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Aug 26, 2026
Summary
Effective July 1, 2026, Ambetter Health's Marketplace product will only reimburse IONM services billed with CMS-recognized payable codes (95940, G0453) and will no longer cover code 95941. All IONM claims must meet 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 30, 2026: Billing team must update all billing software and claim submission rules for Ambetter Marketplace to remove CPT 95941 from billing workflows and ensure only 95940 and G0453 are submitted for IONM services. Update encounter forms and provider documentation templates to reflect that IONM cannot be billed by surgeons or anesthesia providers and reinforce the 4-unit-per-60-minute limitation. Audit current IONM billing practices to identify any claims using 95941 or submitted by ineligible providers. Communicate policy requirements to all surgical teams and anesthesia staff. Starting July 1, 2026, all claims submitted with 95941 or that violate the new criteria (exceeding 4 units per 60 minutes, multiple patient attention, or billing by surgeon/anesthesia) will be denied by Ambetter Marketplace.