26-773 IONM Billing Requirements Change, Effective August 14, 2026
Date: 06/10/26
Bill correctly using CMS-recognized codes and required criteria to avoid claim denials
Health Net is implementing changes to Intraoperative Neurophysiologic Monitoring (IONM) billing requirements and reimbursement criteria, effective August 14, 2026, to align with Centers for Medicare & Medicaid Services (CMS) billing and payment requirements for these services. Physicians, practitioners and other providers must follow these requirements when submitting claims to support accurate processing and avoid denials.
Billing and reimbursement requirements
IONM services must be billed using CMS-recognized payable codes and meet applicable CMS billing and payment requirements. Claims submitted with non-payable or unsupported codes are not eligible for reimbursement and will be denied.
To be eligible for reimbursement, all of the following must be met:
- Monitoring is performed with exclusive, undivided attention to a single patient.
- No more 4 units are billed per 60-minute period.
- Total billed units do not exceed the total monitoring time.
- Services are not billed by the surgeon or anesthesia provider, as they are included in the global surgical package.
- Claims include an appropriate Place of Service code (POS 19, 21, 22, or 24).Covered services
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Need help? Contact us
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center.
Provider Services
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Ambetter from Health Net IFP Ambetter PPO | ||
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Health Net Employer Group HMO, POS, & PPO |
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This information applies to Physicians and Practitioners, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.