ExchangeBilling CodesHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 6/15/26
Ambetter·NV · Neurosurgery, General Surgery, Cardiothoracic Surgery +2 more·Claims & Billing
Effective date
Jun 15, 2026
We identified it
Aug 26, 2026
Summary
Ambetter from SilverSummit Healthplan has updated IONM billing requirements effective 6/15/26 for Marketplace plans. Code 95940 with modifier G0453 is now the only covered service; code 95941 is non-covered. Billing must comply with CMS 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 June 15, 2026: Billing team must (1) update billing system to recognize only CPT 95940 with modifier G0453 as covered for Ambetter Marketplace members and reject claims with CPT 95941; (2) configure system to enforce maximum 4 units per 60-minute period and validate total units do not exceed monitoring time available; (3) add validation requiring Place of Service 19, 21, 22, or 24 on all IONM claims; (4) implement rules to prevent billing of IONM services when billed by surgeon or anesthesia provider; (5) update provider education materials and encounter forms to clarify these restrictions. Failure to comply will result in claim denials for non-compliant submissions. Providers should be notified of coding changes immediately.