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

By June 15, 2026: Billing team must implement the following changes for all Ambetter Marketplace claims: (1) Update billing system to ONLY accept and process CPT code 95940 with HCPCS modifier G0453 for IONM services—reject all other IONM codes including 95941; (2) Configure system edits to enforce the four-unit maximum per 60-minute period and prevent billing units exceeding actual monitoring time; (3) Add validation rules requiring Place of Service codes 19, 21, 22, or 24 only; (4) Add system alert to prevent surgeon and anesthesia providers from billing IONM (included in global surgical package); (5) Update claim scrubbing rules to deny CPT 95941 automatically; (6) Communicate requirements to all providers and coding staff via training or bulletin. Claims submitted without G0453 modifier, exceeding unit limits, using non-approved place of service codes, or using code 95941 will be denied. Update encounter forms and provider documentation templates accordingly.