decisionhealth Newsletters, Part B News - 2016 Issue 7 (July)
New moderate sedation policy includes new billing rules, 7 new codes
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Article Overview
This article covers proposed Medicare physician fee schedule changes affecting moderate sedation billing, including the shift away from carrier-priced reporting and the introduction of new CPT and HCPCS codes. It is relevant to coders, billing staff, physician practices, and specialty groups that report procedures with moderate sedation, especially in settings where Appendix G and time-based reporting are involved. The article also discusses associated RVU updates and the proposed status and payment treatment of the new codes.
Why This Topic Matters
Moderate sedation reporting changes can affect reimbursement, code selection, and workflow across multiple specialties. Organizations that bill for procedures with sedation need to understand the proposed structure, affected service categories, and timing-related changes to prepare for implementation.
Article Sections
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Policy overview and reimbursement changes
Introduces the proposed Medicare and AMA changes affecting moderate sedation reporting and payment. Summarizes the broader reason the policy is being updated and the types of services involved.
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New codes required to implement the policy
Describes the creation of new moderate sedation codes and their planned status under Medicare. Includes discussion of the affected code families and the general transition away from current carrier-priced reporting.
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Get ready for a time change
Explains the proposed shift in time structure for moderate sedation reporting and the relationship between primary and add-on codes. Covers the broad timing framework and how it differs from the current approach.
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Proposed moderate sedation services and fees – 2017
Presents the proposed code list, status indicators, and fee schedule information for the new moderate sedation services. Also identifies the source materials referenced for the proposal.
What You Will Learn
- How proposed moderate sedation billing changes are structured
- Which broad code sets are involved in the new sedation policy
- How the article frames the relationship between sedation services and related procedures
- What categories of fee schedule and RVU changes are discussed
- How the proposed policy affects reporting for general and gastrointestinal endoscopy services
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Physician practices
- Gastroenterology practices
- Compliance and revenue cycle teams
Codes Discussed
Code Ranges Discussed
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