Moderate Sedation: Report the New Codes--But Don't Hold Out for Pay

Article Overview

This article covers the introduction of new CPT moderate sedation codes in 2006, Medicare’s initial carrier-priced status for those codes, and the resulting reimbursement uncertainty. It is relevant to physicians, coders, and reimbursement staff who track billing policy changes, payer responses, and guidance from CMS, the AMA, and carrier-level coverage decisions. The article also discusses how different payer types may respond and why providers are being encouraged to monitor local coverage developments.