ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 6/15/26
Ambetter·KY · Neurosurgery, General Surgery, Cardiothoracic Surgery +1 more·Claims & Billing
Effective date
Jun 15, 2026
We identified it
Aug 26, 2026
Summary
Ambetter from WellCare of Kentucky updated IONM billing requirements effective 6/15/26. Only CMS-recognized payable code 95940 with modifier G0453 is covered for Marketplace plans; code 95941 is non-covered. Billing must follow strict criteria including exclusive patient attention, max 4 units per 60 minutes, appropriate place of service codes, and cannot be billed by surgeon/anesthesia provider.
Action Required
By June 15, 2026: Billing team must immediately update all billing system rules to ONLY accept CPT 95940 with HCPCS modifier G0453 for Ambetter Marketplace plans in Kentucky. Flag and deny all claims for CPT 95941 (non-covered service). Update claim submission templates to enforce: (1) exclusive single-patient monitoring documentation requirement, (2) maximum 4 units per 60-minute period validation, (3) Place of Service restrictions to only codes 19, 21, 22, or 24, and (4) rejection rules if billing surgeon or anesthesia provider. Configure system to cross-reference global surgical package rules to prevent duplicate billing. Notify all providers and surgical centers performing IONM procedures in Kentucky of billing requirement changes. Review all pending IONM claims for Ambetter Marketplace members and resubmit with corrected codes/modifiers. Claims submitted after 6/15/26 with 95941 or improper modifiers will be denied.