This article is for anesthesiologists and gastroenterologists caring for our members
As a reminder, effective January 1, 2024, we will implement diagnosis-driven claim edits to reinforce our existing monitored anesthesia care (MAC) medical policy 154 guidelines.
For our enforcement of this policy on January 1, 2024, it’s important to know that we cover monitored anesthesia care for endoscopic procedures such as colonoscopies and upper endoscopies when medically necessary. Medical policy 154 lists diagnosis codes and clinical scenarios where monitored anesthesia care is medically necessary for endoscopic procedures, outlined by certain medical conditions and complication risks.
Our medical policy aligns with the American Society of Gastrointestinal Endoscopy (ASGE), American College of Gastroenterology, American Gastroenterological Association, and American Society of Anesthesiologists (ASA) guidelines.
As a result of processing claims in accordance with our policy on a pre-payment basis, we are able to reduce the number of claims needing post-payment review.
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