ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 9/1/26
Ambetter·AR · Neurosurgery, Orthopedics, Cardiothoracic Surgery +2 more·Claims & Billing
Effective date
Sep 1, 2026
We identified it
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.
Action Required
By August 31, 2026: Billing team must update billing system to enforce IONM coding restrictions for Ambetter Marketplace plans. (1) Configure system to accept ONLY CPT 95940 and HCPCS G0453 for reimbursement and deny claims with CPT 95941. (2) Add hard stops to prevent billing more than 4 units per 60-minute period. (3) Verify total units billed do not exceed actual monitoring time. (4) Update place of service validation to accept ONLY codes 19, 21, 22, or 24 for IONM claims. (5) Add billing rules to prevent IONM claims when billed by surgeon (provider type) or anesthesia provider. (6) Educate billing team and providers that IONM services cannot be billed as separate line items when included in global surgical package. (7) Configure system to reject non-compliant claims before submission. Failure to implement will result in claim denials for non-compliant IONM services.