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Moderate Sedation Billing and Appendix G Codes

Each year, the American Medical Association (AMA) editorial board updates the list of CPT® codes by adding new codes and revising or deleting certain existing codes.1

Effective January 1, 2017, the AMA replaced CPT codes 99143, 99144, 99145, 99148, 99149 and 99150 with new moderate sedation codes 99151, 99152, 99153, 99155, 99156, 99157 and G0500.

Although we recognize that 2017 Centers for Medicare & Medicaid Services (CMS) guidelines advise practitioners to bill moderate sedation separately when provided along with more than 400 procedure codes (formerly included in Appendix G, Summary of CPT Codes That Include Moderate Conscious Sedation), Horizon BCBSNJ’s 2017 allowances for these codeswill continue to includemoderate sedation as part of our allowance.

Since Horizon BCBSNJ will continue to include moderate sedation as part of our allowances for these procedures, practitioners should NOT bill separately for moderate sedation when provided with these services.

We will review claim submissions and reimbursement and recover any overpayments made.

If you have questions, contact your Network Specialist.

1 Information on new and updated CPT codes is available on the AMA website.

CPT® is a registered mark of the American Medical Association

Published on: March 22, 2017, 16:04 p.m. ET
Last updated on: March 22, 2017, 16:45 p.m. ET