Moderate sedation services have historically always been bundled into the majority of all applicable CPT procedures. More than 400 codes that were previously defined as including moderate sedation have been deleted from Appendix G. In addition to six new CPT codes and one new endoscopy-specific HCPCS code, CMS intends to create a “uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure” with this year’s CPT updates. Providers who perform moderate sedation with a procedure must report the appropriate new moderate sedation codes to receive full reimbursement. As a result of removing this long time bundling edit, many procedures will see a slight reduction in RVU.n
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- 99151 – Moderate sedation services provided by the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
- 99152 – Initial 15 minutes of intraservice time, patient age 5 years or older
- 99153 – Each additional 15 minutes intraservice time
- 99155 – Moderate sedation services provided by the physician or other qualified health care professional other than the physician performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
- 99156 – Initial 15 minutes of intraservice time, patient age 5 years or older
- 99157 – Each additional 15 minutes intraservice time
- G0500 – Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports
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