2016-03-16 13:54:24 UTC

Changes Coming to Moderate Sedation Will Impact GI Procedures

March 16, 2016

CMS intends to remove the value of moderate sedation from all GI endoscopy codes.

AGA, ACG and ASGE continue to be dismayed by the values for colonoscopy and other GI endoscopy procedures, which have sustained drastic cuts over the past four years. In addition, in recent rulemaking, CMS announced plans to remove the value of moderate sedation from nearly all GI endoscopy codes to prevent duplicative payment to the endoscopist for moderate sedation when anesthesia is provided and billed by a second provider. This means that reimbursement for GI endoscopy procedures will be further reduced if the endoscopist doesn’t administer moderate sedation. The value of moderate sedation will impact the degree of the reduction.

On Feb. 29, the GI societies met with officials at CMS to discuss colonoscopy values, the agency’s plan to value moderate sedation, and the impact of these actions on the 80 by 2018 pledge taken by over 690 organizations. We emphasized the need for appropriate valuation of moderate sedation that preserves the value of the endoscopy procedures. If too much value is assigned to moderate sedation, the underlying procedures could be significantly devalued relative to all other procedures. 

Gastroenterologists have already sustained drastic cuts. Additional cuts to colonoscopies have the potential to severely impede progress toward the goal of 80 percent screened for colorectal cancer by 2018.

What Does This Mean for GIs?

  • CMS plans to remove the value of moderate sedation from over 120 GI endoscopy codes. We may know more when the 2017 Medicare Physician Fee Schedule proposed rule is released this summer.
  • CPT has created new codes to describe administration of moderate sedation when performed by the endoscopist, which will become effective in 2017.
  • CMS says no extra value will be added when the new CPT codes for moderate sedation are reported with the GI endoscopy procedure. 
  • Endoscopists administering moderate sedation during procedures will likely report these new moderate sedation codes along with the underlying procedural code.
  • Endoscopists not administering moderate sedation will only report the underlying procedural code. 
  • Anesthesiology professionals who administer anesthesia during GI endoscopy procedures will continue to be reimbursed separately for their work.

AGA and the other GI societies will continue to fight to ensure that the impact of the removal of the value of moderate sedation from endoscopy procedures does not unfairly penalize gastroenterologists. 

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