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AmbetterExchange · Coverage · Claims & Billing · AR · Neurosurgery, Orthopedics, Cardiothoracic Surgery +2 moreHigh impact

Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 9/1/26

Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
Aug 26, 2026

Summary

Ambetter from Arkansas Health & Wellness is updating IONM billing requirements effective September 1, 2026. For Marketplace plans, only CMS-recognized payable codes (95940, G0453) are reimbursable; 95941 is non-covered. Billing must comply with strict criteria including exclusive patient attention, maximum 4 units per 60 minutes, appropriate place of service codes, and cannot be billed by surgeon or anesthesia provider.

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What to do

by Aug 31, 2026 · 8 steps
01Billing team must update billing system to enforce IONM coding restrictions for Ambetter Marketplace plans.
02Configure system to accept ONLY CPT 95940 and HCPCS G0453 for reimbursement and deny claims with CPT 95941.
03Add hard stops to prevent billing more than 4 units per 60-minute period.
04Verify total units billed do not exceed actual monitoring time.
05Update place of service validation to accept ONLY codes 19, 21, 22, or 24 for IONM claims.
06Add billing rules to prevent IONM claims when billed by surgeon (provider type) or anesthesia provider.
07Educate billing team and providers that IONM services cannot be billed as separate line items when included in global surgical package.
08Configure system to reject non-compliant claims before submission.
If missed: Failure to implement will result in claim denials for non-compliant IONM services.

Codes mentioned

95940G045395941

Original notice

Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 9/1/26
ambetterhealth.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Ambetter policiesAR policy changesNeurosurgeryOrthopedicsCardiothoracic SurgeryGeneral SurgeryAnesthesiologyCode 95940Code G0453Code 95941

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