CurrentAnthemPolicy C-24002

Intraoperative Neuromonitoring (IONM) reimbursement

Defines Anthem's reimbursement rules for intraoperative neuromonitoring services billed by professional providers and the required billing practices, place of service, and modifiers; applies to Anthem commercial plans where not superseded by contract or law.

Policy Summary

PayerAnthem

PolicyIntraoperative Neuromonitoring (IONM) reimbursement

Policy CodePolicy C-24002

Change TypeMinor technical update

Effective Date11/01/2024

Next Review DateN/A

Key ActionBill IONM professional services on a CMS-1500 with place of service 19, 21, 22, or 24; UB-04 submissions will be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4allowed POS

11/01/2024effective

2024-06-12last approval

C-24002policy #

Reimbursement and Coverage Criteria

Reimbursement criteria

Covered when ALL of the following are met:

ALL of the following

Place of service
- Service is billed with place of service 19 (Off campus-outpatient hospital)
- Service is billed with place of service 21 (Inpatient hospital)
- Service is billed with place of service 22 (On campus-outpatient hospital)
- Service is billed with place of service 24 (Ambulatory surgical center)

Policy Summary

PayerAnthem

PolicyIntraoperative Neuromonitoring (IONM) reimbursement

Policy CodePolicy C-24002

Change TypeMinor technical update

Effective Date11/01/2024

Next Review DateN/A

Key ActionBill IONM professional services on a CMS-1500 with place of service 19, 21, 22, or 24; UB-04 submissions will be denied.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coding and Place of Service

IONM coding guidancemixed

No codes listed

Place of service requirement

Required places of serviceIONM must be billed using the member's location and one of these POS codes: 19 (Off campus–outpatient hospital), 21 (Inpatient hospital), 22 (On campus–outpatient hospital), or 24 (Ambulatory surgical center).

Biller type constraintRequirement applies when IONM is billed by a professional provider; facility or contractual exceptions may supersede.

Form requirementIONM professional services must be billed on a CMS-1500; submissions on a UB-04 will be denied.

Location vs monitoring physicianMonitoring must be performed in the hospital setting indicated by the member's location even if the monitoring physician is located in an office.

Responsibility for equipment and technical staffProvision of equipment, supplies, and technical personnel for IONM is the responsibility of the facility rendering the IONM service.

Billing and Provider Reporting Requirements

Billing Rule

Billing and provider reporting requirements for IONM

IONM codes must be billed on a CMS-1500; submissions on a UB-04 will be denied. Monitoring must be reported with the place of service where the member is located: Off campus-outpatient hospital (19), Inpatient hospital (21), On campus-outpatient hospital (22), or Ambulatory surgical center (24). If the provider serves as the IONM supervising physician, the supervising physician should report modifier 26. IONM should not be reported by the operating surgeon or anesthesiologist when the service is included in the global package. The facility is responsible for equipment, supplies, and technical personnel for the IONM service.

IONM services billed on a UB-04 will be denied; bill on a CMS-1500.
Use POS 19, 21, 22, or 24 — report the place of service where the member is located.
Supervising physician should report modifier 26 when serving as the IONM supervising physician.
Do not report IONM by the operating surgeon or anesthesiologist when it is included in the global package.
Facility is responsible for providing equipment, supplies, and technical personnel for IONM.

Key Definitions

Intraoperative Neuromonitoring (IONM)

DefinitionMonitoring that uses recordings of the nervous system's electrical response to stimulation of specific neural pathways (e.g., visual, motor, auditory, general sensory evoked response studies) to obtain information on the functional integrity of pathways within the nervous system during an operative procedure.

PurposeTo obtain information on functional integrity of neural pathways during an operative procedure.

Example modalitiesIncludes visual, motor, auditory, and general sensory evoked response studies as examples of monitored pathways.