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New Payment Policy Effective August 1, 2026 - Intraoperative Neurophysiology Monitoring (IONM)

Date: 06/09/26

Ambetter Health (Ambetter from Superior HealthPlan and Ambetter Health Solutions) presents a new payment policy. The following policy is posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for review, prior to its implementation.

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

 Payment Policy: Intraoperative Neurophysiology Monitoring (IONM)

(TX.CC.PP.503)

August 1, 2026

Ambetter Health

This Payment Policy defines reimbursement parameters for continuous intraoperative neurophysiology monitoring services. The policy incorporates CMS payment guidance, American Academy of Neurology (AAN), and industry standards. 

To facilitate reimbursement for intraoperative neurophysiology monitoring, the following criteria must be met:

  1. Monitoring services are provided with exclusive, undivided attention to one patient; and
  2. No more than four (4) units may be billed per 60-minute period; and
  3. Total units billed must not exceed the total monitoring time available; and
  4. The service is not billed by the surgeon or anesthesia provider, as it is included in the global surgical package; and
  5. The service is billed with an appropriate Place of Service (POS 19, 21, 22, or 24).

 

To review all clinical payment or payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact your Provider Representative. To access their contact information visit Find My Provider Representative.