Has anyone been using moderate sedation codes G0500 - 99153 on Medicare claims? Is it reimbursed? Do they cover it for a screening colonoscopy only and not diagnostic or EGD?I find it confusing that in MLN Matters (MM 10075) the implementation date of these codes is Oct 2, 2017 yet in MCR Publication (# 100-04 transmittal: 3763) all contractors are asked to pay for them on claims dated Jan 1, 2017 or later.Any feedback appreciated!
Clinical Example (99152)
A patient undergoes a procedure that requires moderate sedation. The treating physician will perform both the supported procedure and the moderate sedation service. The physician will supervise and direct an independent, trained observer who will assist in monitoring the patient's level of consciousness and physiologic status throughout the procedure.
Description of Procedure (99152)
The physician or other qualified health care professional performs presedation patient assessment; supervises or personally provides the administration of the sedating agent, with or without an analgesic; and supervises an independent, trained observer who monitors the patient's level of consciousness and physiologic status throughout the procedure. The patient is assessed continuously throughout the procedure to achieve an effective and safe level of moderate sedation. Additional doses of the sedating agent(s) are ordered or provided by the physician as needed. The physician's intraservice time ends when the procedure is complete, the patient is physiologically stable, and face-to-face physician time is no longer required.
In the situation in which the physician is performing the surgical/endoscopic procedure and is performing the sedation inside a facility (hospital, ASC), the surgeon can bill only the initial 15 minutes with CPT 99152 (or 99151). These codes include relative value units (RVUs) for the physician work of initiating the sedation. The subsequent intervals of time include no physician work and would not be billed by the surgeon; the work of 99153 represents work of a hospital employee, so is included in reimbursement to the hospital not the surgeon.
Note that the Medicare Physician Fee Schedule for CPT code 99153 includes zero RVUs for physician work, and, more important, that the PC/TC Indicator is "3". A PC/TC Indicator of "3" is assigned to codes representing the technical component only, so codes with this indicator are never paid to a professional through Part B when billed from a facility place of service.