Moderate sedation services

Applies to:

All plans

Medicare plans follow Medicare rules for coverage and billing.

Definition

Moderate (conscious) sedation is a drug-induced depression of consciousness. The patient maintains the ability to respond purposely to verbal direction or verbal direction either alone or accompanied by light tactile stimulation. Source: acep.org

Medical policy 

• Moderate Sedation for Interventional Pain Management - 91632

Moderate sedation billing

Payable: When billed by the same physician or qualified health professional who performs the service requiring sedation 

Not payable: By a separate anesthesiologist

Sedation with surgery

When a provider bills the moderate sedation codes in addition to surgical code(s), notes may be requested. Refer to the CPT manual for moderate sedation codes.