ExchangeCoverageHigh impact
Intraoperative Neurophysiologic Monitoring (IONM) Update: Effective 8/1/26
Ambetter·TN · Neurosurgery, Cardiothoracic Surgery, Orthopedics +2 more·Claims & Billing
Effective date
Aug 1, 2026
We identified it
Aug 26, 2026
Summary
Effective August 1, 2026, Ambetter of Tennessee is implementing new billing requirements for Intraoperative Neurophysiologic Monitoring (IONM) services on Marketplace plans. Only CMS-recognized payable code 95940 (with G0453 modifier) is covered; code 95941 is non-covered. Claims must meet strict criteria including exclusive patient attention, maximum 4 units per 60 minutes, appropriate place of service codes, and cannot be billed by surgeons or anesthesia providers.
Action Required
By July 15, 2026: Billing team must update claims processing system to (1) only allow CPT 95940 with G0453 modifier for Ambetter Tennessee Marketplace plans and deny CPT 95941 claims automatically; (2) add validation rules to enforce maximum 4 units per 60-minute period; (3) verify place of service codes are 19, 21, 22, or 24 before claim submission; (4) add alerts to prevent billing when surgeon or anesthesia provider is listed as service provider. Update provider communication templates to clarify IONM must be billed by an independent neurophysiologist. Notify all surgical departments and anesthesia staff of these restrictions. Claims submitted after August 1, 2026 that violate these criteria will be denied by Ambetter.