ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 8/1/26
Ambetter·NH · Neurosurgery, General Surgery, Cardiothoracic Surgery +2 more·Claims & Billing
Effective date
Aug 1, 2026
We identified it
Aug 26, 2026
Summary
Effective August 1, 2026, Ambetter from NH Healthy Families is restricting IONM (Intraoperative Neurophysiologic Monitoring) reimbursement to CMS-recognized payable codes only. Code 95940 with modifier G0453 is now covered; code 95941 is non-covered. Billing must comply with strict requirements including exclusive patient attention, maximum 4 units per 60 minutes, appropriate place of service codes, and cannot be billed by surgeon or anesthesia provider.
Action Required
By July 31, 2026: Billing team must update claims submission software to only allow CPT 95940 with modifier G0453 for Ambetter NH Marketplace plans and systematically deny or reject CPT 95941. Create billing edit rules to enforce: (1) exclusive single-patient monitoring documentation requirement, (2) maximum 4-unit limit per 60-minute period in billing system validation, (3) Place of Service validation (only 19, 21, 22, or 24 accepted), and (4) automatic rejection if surgeon or anesthesia provider is listed as billing provider. Train billing staff to deny claims not meeting these criteria. Notify surgical and anesthesia providers that IONM billing cannot originate from their provider numbers per global surgical package rules. Update billing software claim scrubbing logic and communicate policy to all facility billing contacts. Failure to implement will result in claim denials and payment delays.