CurrentUnitedHealthcarePolicy 2026R9041A

Intraoperative Neuromonitoring (IONM) reimbursement

Governs reimbursement rules for intraoperative neuromonitoring services billed on the CMS 1500 form for UnitedHealthcare Medicare Advantage plans and affects network physicians and qualified health care professionals.

Policy Summary

PayerUnitedHealthcare

PolicyIntraoperative Neuromonitoring (IONM) reimbursement

Policy CodePolicy 2026R9041A

Change TypeAdministrative (non‑material)

Effective Date

Next Review Date

Key ActionDo not report 95940 or G0453 when performed by the physician performing the operative or anesthesia procedure; reimburse only with POS 19, 21, 22, or 24.

SourceLink

POLICY UPDATE CHANGES

History section entries prior to 2/1/2024 were removed.

History section entries prior to 2/1/2023 were removed.

Policy logo updated on 2/1/2024.

4allowed POS for reimbursement

2not reportable codes by operating/anesthesia physician

CMS 1500claim form governed

Medicare Advantageapplicability

Coverage Criteria

IONM reimbursement criteria

Reimbursement allowed only when reporting and setting criteria are met.

ALL of the following

IONM services (e.g., CPT 95940, G0453) are reimbursed only when billed with Place of Service 19, 21, 22, or 24.
IONM codes are reported based on time spent monitoring only; time excludes baseline setup, recording and interpretation of baseline studies, and electrode removal.
Per CMS, intraoperative neurophysiology testing codes 95940 and G0453 should not be reported by the physician performing the operative or anesthesia procedure (included in the global package); modifiers 26 and TC do not apply.
EXCLUSIONS

Policy Summary

PayerUnitedHealthcare

PolicyIntraoperative Neuromonitoring (IONM) reimbursement

Policy CodePolicy 2026R9041A

Change TypeAdministrative (non‑material)

Effective Date

Next Review Date

Key ActionDo not report 95940 or G0453 when performed by the physician performing the operative or anesthesia procedure; reimburse only with POS 19, 21, 22, or 24.

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 Time Reporting

IONM service codesCPT

95940	Intraoperative neurophysiology monitoring; each 15 minutes of monitoring
G0453	Intraoperative neurophysiology monitoring (IONM) of central nervous system, per hour

Time Reporting Rule

Time-reporting ruleReport IONM codes based only on time spent monitoring; exclude time to set up, record and interpret baseline studies, and time to remove electrodes; baseline studies are separately reportable.

Do not count baseline proceduresDo not count time spent performing or interpreting baseline neurophysiologic study(ies) as intraoperative monitoring; they represent separately reportable procedures.

Unit of reportingIONM codes are reported based on monitoring time, not on the number of baseline tests performed or parameters monitored.

Provider Actions and Billing Restrictions

Billing Rule

Do not report 95940 or G0453 when performed by the operating/anesthesia physician; limit reimbursement to POS 19, 21, 22, 24

Do not report CPT 95940 or HCPCS G0453 when the monitoring is performed by the physician who is also performing the operative or anesthesia procedure; CMS states these tests are included in the global package. UnitedHealthcare Medicare Advantage will only reimburse 95940 and G0453 when billed with Place of Service 19, 21, 22, or 24. Services furnished in a mobile unit (POS 15) are not reimbursed.

Per CMS, intraoperative neurophysiology testing codes 95940 and G0453 should not be reported by the physician performing the operative or anesthesia procedure (included in the global package).
Only reimburse 95940 and G0453 when reported with POS 19, 21, 22, or 24.
Services furnished in a mobile unit (POS 15) will not be reimbursed.

Definitions

Intraoperative Neuromonitoring (IONM) — Definition

DefinitionIntraoperative Neuromonitoring (IONM) is the use of electrophysiological methods to monitor the functional integrity of neural structures during surgery to reduce risk of nervous system damage and provide functional guidance to the surgeon and anesthesiologist.

PurposeReduce risk of damage to the patient’s nervous system and provide functional guidance to the surgical and anesthesia teams.

Governing guidanceDefinition sourced from the American Medical Association as cited in the policy.

IONM Time Reporting — Clarifications

Monitoring time exclusionsTime spent monitoring excludes time to set up, record, and interpret baseline studies and time to remove electrodes at the end of the procedure.

Baseline studiesTime performing or interpreting baseline neurophysiologic study(ies) should not be counted as intraoperative monitoring and are separately reportable.

Reporting basisIONM codes are reported based on monitoring time only, not on number of baseline tests or parameters monitored.