CurrentAmbetter NevadaPolicy CC.PP.503

Intraoperative Neurophysiology Monitoring (IONM) - Reimbursement Policy

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Defines Centene/Ambetter Nevada reimbursement and billing rules for continuous intraoperative neurophysiology monitoring (IONM) across Medicare Advantage, Marketplace, and Medicaid products, subject to state-specific Medicaid requirements and member benefit documents.

Policy Summary

PayerAmbetter Nevada

PolicyIntraoperative Neurophysiology Monitoring (IONM) - Reimbursement Policy

Policy CodePolicy CC.PP.503

Change TypeNo material change

Effective DateJun 1, 2026

Next Review Date

Key ActionBill IONM services using CMS-recognized payable codes (+95940 or +G0453) with exclusive one-to-one monitoring, in 15-minute increments, and no more than four units per 60 minutes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2primary payable procedure codes referenced

4maximum units per 60 min

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CurrentAmbetter NevadaPolicy CC.PP.503

Intraoperative Neurophysiology Monitoring (IONM) - Reimbursement Policy

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Sign up for Ambetter Nevada Policy CC.PP.503 alerts

Get alerted when Policy CC.PP.503 changes without checking for updates manually.

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Policy Summary

PayerAmbetter Nevada

PolicyIntraoperative Neurophysiology Monitoring (IONM) - Reimbursement Policy

Policy CodePolicy CC.PP.503

Change TypeNo material change

Effective DateJun 1, 2026

Next Review Date

Key ActionBill IONM services using CMS-recognized payable codes (+95940 or +G0453) with exclusive one-to-one monitoring, in 15-minute increments, and no more than four units per 60 minutes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2primary payable procedure codes referenced

4maximum units per 60 min

Coverage criteria for continuous IONM

Reimbursement is allowed only when CMS-recognized payable codes and ALL of the following criteria are met. Services that do not meet these criteria are not covered.

ALL of the following

ALL of the following
- CPT +95940 must be used when monitoring is performed in the operating room with one-to-one monitoring; reported in 15-minute increments
  CPT +95940 is a payable code for continuous OR one-to-one monitoring
- HCPCS +G0453 must be used for continuous remote IONM requiring exclusive attention to one patient; reported in 15-minute increments
  HCPCS +G0453 is a payable code for continuous remote monitoring
EXCLUDED CODES
- CPT +95941 (continuous IONM performed remotely or for concurrent monitoring of more than one case) — non-covered
  +95941 describes remote or concurrent monitoring >1 case and is excluded from coverage
ALL of the following
- Monitoring services must be provided with exclusive, undivided attention to one patient (one-to-one monitoring)
  One-to-one monitoring requirement
- No more than four (4) units may be billed per 60-minute period<= 4 units per 60 minutes
- Total units billed must not exceed the total monitoring time available
- The service must not be billed by the surgeon or anesthesia provider (included in the global surgical package)
- The service must be billed with an appropriate Place of Service (POS 19, 21, 22, or 24)
ALL of the following
- CPT +95940 and HCPCS +G0453 must be billed in addition to the primary surgical procedure code
- Billing must comply with CMS time-based reporting rules and current coding guidance (codes, modifiers, units, POS)

ALL of the following

Inclusion or exclusion of a code does not guarantee coverage; determinations are subject to member benefit documents, provider contracts, CMS requirements, and plan-level policies
Providers are responsible for reporting the most current and appropriate codes, modifiers, units of service, and place of service in accordance with CMS, CPT, HCPCS, and other coding standards

ALL of the following

Applies to physician services, non-physician practitioner services, and outpatient institutional claims across applicable products unless superseded by state Medicaid rules or member-specific benefits

ALL of the following

Services reported in 15-minute increments15-minute increments
Maximum billable rate is four units per 60-minute period<= 4 units per 60 minutes

Payable codes, units, and reporting increments

Covered IONM CodesCPT | HCPCSCovered

95940	Continuous IONM performed in the operating room with one-to-one monitoring, each 15 minutes
G0453	Continuous remote IONM requiring exclusive attention to one patient, reported in 15-minute increments

Non-covered / Excluded IONM CodesCPTNot Covered

95941

Continuous IONM performed remotely or for concurrent monitoring of more than one case.

Maximum units per hour

Maximum units per 60-minute periodNo more than four (4) units may be billed per 60-minute period

Billing relation to monitoring timeTotal units billed must not exceed the total monitoring time available

Unit cap rationaleAligned to CMS time-based billing guidance for continuous IONM

Unit reporting increments

Unit incrementsReported in 15-minute increments

Code examples using incrementsCPT +95940 and HCPCS +G0453 are reported in 15-minute increments

Billing and provider requirements for IONM

Billing Rule

Billing and provider requirements for IONM

Bill continuous IONM only with CMS-recognized payable codes +95940 or +G0453, reported in 15-minute increments and in addition to the primary surgical procedure code; follow CMS time‑based reporting rules and report appropriate modifiers, units, and Place of Service (POS 19, 21, 22, or 24). Ensure monitoring is exclusive, one-to-one (undivided attention to one patient), limit billing to no more than four units per 60-minute period, and do not bill the service by the surgeon or anesthesia provider (it is included in the global surgical package). Failure to follow these billing and provider requirements risks claim denial or nonpayment.

Use CPT +95940 or HCPCS +G0453 and bill in 15-minute increments.
Bill IONM in addition to the primary surgical procedure code and comply with CMS time-based reporting rules.
Do not bill more than four (4) units per 60-minute period; total units must not exceed monitoring time.
Provide exclusive, undivided attention to one patient (one-to-one monitoring).
Do not bill the service by the surgeon or anesthesia provider; use appropriate Place of Service (POS 19, 21, 22, or 24).
Report current and appropriate codes, modifiers, units, and POS per CMS, CPT, and HCPCS guidance to avoid denials.

Key definitions and terms

CMS-recognized payable codes

DefinitionCMS-recognized payable codes: procedure codes that CMS recognizes and permits for payment for IONM services (e.g., +95940, +G0453)

Billing requirementServices must be billed using CMS-recognized payable codes for Medicare Advantage, Marketplace, and Medicaid unless state Medicaid rules supersede

Non-payable consequenceServices billed with codes not recognized or payable under CMS guidance are not eligible for reimbursement

One-to-one monitoring requirement

Exclusive, undivided attentionMonitoring must be performed with exclusive, undivided attention to one patient (one-to-one monitoring)

Operational implicationIONM personnel must not concurrently monitor multiple cases or patients during the billed time period