The administration of moderate sedation, also known as conscious sedation, for specified procedures, by the same provider (99143-99145), regardless of specialty, is not eligible for separate payment. Reimbursement for moderate) sedation is included in the global allowance for these procedures and, therefore, is not separately reimbursable. A participating, preferred, or network provider cannot bill the member for the moderate sedation. (The procedure codes representing these services are listed in the Procedure Code Attachment below.)

Moderate sedation performed with any other surgical procedure by the same provider remains not covered. A participating, preferred, or network provider can bill the member for the sedation in these cases. (See Highmark Medical Policy Bulletin A-2 for these guidelines.)

Moderate sedation performed by other than the operating surgeon, assistant surgeon, or attending professional (99148-99150) for a covered surgical service remains eligible for separate payment.

Description

Moderate sedation induces an altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives. Patients who receive moderate sedation usually are able to speak and respond throughout the procedure.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

PRN References

10/2004, Conscious sedation administered for endoscopic procedures, by same provider not paid separately