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We are postponing our monitored anesthesia care claim edits
January 24, 2024

This article is for anesthesiologists and gastroenterologists caring for our members

We previously notified you that effective for dates of service on or after January 1, 2024, we would implement diagnosis-driven claim edits to support our monitored anesthesia care (MAC) medical policy 154 guidelines.

As a reminder, our medical policy indicates 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.

After careful review, we have decided to postpone the claim edits that enforce this medical policy until further notice. We will notify you 90 days in advance of any future enforcement of this policy.