Wiki Blue Shield of CA including Moderate Sedation

[SCCL5558]

We just started receiving denials for 99144 from Blue Shield of CA stating that as of 7/1/13 "Reimbursement is not allowed for moderate sedation as a separate service when it is administered and monitored by the same physician who performs the procedure for which the moderate sedation is used.

Anyone else dealing with this?? How can this be??

 

[Michele Hannon]

99144 describes Moderate Sedation provided by the SAME physician performing the diagnostic/therapeutic service that the sedation supports for patients greater than 5 years of age for the first 30 min.
99145 for each additional 15 minutes.

Moderate Sedation includes pre-procedure assessment of the patient, establishing IV access, administration of agents, maintenance of sedation, monitoring/recording of O2 sat, BP, HR and recovery of the patient.

 

[SCCL5558]

Right. No I understand the description of the service.

We are billing for example....
64483
99144

The 64483 is getting paid but Blue Shield of CA is denying the 99144 stating it is included. They just put out a payment policy effective 7/1/13 stating they will no longer pay 99144 (Conscious Sedation). I was wondering if anyone else is seeing this?

 

[Michele Hannon]

Here's your link effective July 1, 2013:
https://www.blueshieldca.com/provid...nload/public/bscpolicy/Mod_SedationAnesth.pdf
My apologies......misunderstood your question.
You ask how can this be? Most Blues are for-profit entities that are taxed like businesses and therefore function like a for-profit business. Every business is trying to find ways to increase their profit margin.