151 Farmington Avenue
Hartford, CT 06156
Dear Physician or Practice Manager:
Monitored Anesthesia Care (MAC) reimbursement changes for GI procedures
For patients 18 to 65, MAC codes 00740 or 00810 will not be eligible for separate payment for upper and lower endscopy procedures performed in the physician’s office and billed with modifiers P1, P2 or with no modifier
MAC codes 00740 or 00810 will be eligible for payment at the moderate sedation rate (CPT4) codes 99149 and 99150 for upper and lower endoscopy procedures performed in an ambulatory surgery center or hospital and billed with modifier P1,P2 or with no modifier when submitted by an anesthesiologist or certified registered nurse anesthetist.
Beginning September 1, 2006, we are modifying our payment practices for MAC services administered during an upper or lower gastrointestinal endoscopy procedure.
We’re making this change based on input from key medical societies
We made this decision after consulting with the American Society of Anesthesiologists and American Society for Gastrointestinal Endoscopy, along with reviewing a document published March 8, 2004, from the American Society for Gastrointestinal Endoscopy. You can view this document online at www.gasto.org/wmspage.cfm?parml=371
How to reach us
Thank you for your continued participation in the Aetna network. Our Provider Service Center representatives are available at:
service Center representative at 1-800-624-0756 for calls related to HMO-based benefits plans or 1-888-MD-AETNA (1-888-632-3862) for calls related to indemnity and PPO-based benefits plans.
James D. Cross, M.D.
Head Of medical Policy Administration