ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 6/16/26
Ambetter·SC · Neurosurgery, Cardiothoracic Surgery, General Surgery +2 more·Claims & Billing
Effective date
Jun 16, 2026
We identified it
Aug 26, 2026
Summary
Effective June 16, 2026, Ambetter from Absolute Total Care is implementing new billing requirements for Intraoperative Neurophysiologic Monitoring (IONM) services on Marketplace plans. Only CMS-recognized payable code 95940/G0453 is covered; code 95941 is non-covered. All claims must meet five specific criteria including exclusive patient attention, maximum 4 units per 60 minutes, appropriate place of service, and must not be billed by surgeon or anesthesia provider.
Action Required
By June 16, 2026: Billing team must update billing system configuration to (1) block claims for CPT 95941 for Ambetter Marketplace plans as non-covered; (2) restrict CPT 95940/G0453 billing to maximum 4 units per 60-minute period with system validation rules; (3) require place of service codes 19, 21, 22, or 24 on all IONM claims; (4) add claim edit to prevent IONM billing by surgeon or anesthesia provider roles; (5) ensure claims documentation reflects exclusive, undivided attention to single patient. Update encounter templates and provider billing instructions to clarify these requirements. Train billing staff on new denial reasons. Implement pre-submission edits to catch non-compliant claims before submission. Failure to comply will result in claim denials and loss of reimbursement.