| Clinical UM Guideline |
| Subject: Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures | |
| Guideline #: CG-MED-34 | Publish Date: 04/15/2026 |
| Status: Reviewed | Last Review Date: 02/19/2026 |
| Description |
This document addresses the medical necessity of the use of monitored anesthesia care (MAC) during gastrointestinal (GI) endoscopic procedures. This document does not address whether or not reimbursement is provided for the anesthesia service and it is not intended to guide the billing and reimbursement of anesthesia services.
Note: Please see the following related document for additional information:
Note: For a high-level overview of this document, please see “Summary for Members and Families” below.
| Clinical Indications |
Medically Necessary:
Monitored Anesthesia Care (for definition, see Discussion below)
Monitored anesthesia care is considered medically necessary during gastrointestinal endoscopic procedures when there is documentation by the operating physician or the anesthesiologist that demonstrates any of the following higher risk situations exist:
The routine assistance of an Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) for individuals meeting the above criteria who are undergoing gastrointestinal endoscopic procedures is considered medically necessary.
Not Medically Necessary:
Monitored anesthesia care is considered not medically necessary when the above criteria are not met.
The routine assistance of an Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) for individuals not meeting the above criteria who are undergoing gastrointestinal endoscopic procedures is considered not medically necessary.
| Summary for Members and Families |
This document describes clinical studies and expert recommendations, and explains when it is appropriate to provide special sedation with close monitoring during a procedure using a flexible camera to look inside the digestive tract. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.
Key Information
Monitored anesthesia care (MAC) is a special type of anesthesia service where a trained medical professional closely monitors a person during procedures, such as colonoscopy or upper endoscopy. MAC is sometimes needed when people are at higher risk of complications, such as those who are very young or old, pregnant, have serious health conditions, or have known problems with standard sedatives. The person giving MAC can adjust care during the procedure and manage deeper sedation if needed. While sedation is safe for most people, using MAC in certain situations helps keep people safer and more comfortable.
What the Studies Show
Several studies have looked at how safe and effective MAC is during gastrointestinal (GI) procedures. Research shows that most people have very low risk of complications during sedation for these procedures. Some studies compared deep sedation with moderate sedation and found similar results for safety and comfort, although doctors tended to prefer deep sedation. One study showed that general anesthesia might reduce some breathing problems during high-risk procedures compared to MAC, but those results may not apply to all hospitals. Overall, using MAC does not always improve health outcomes but may be safer for certain people with high-risk conditions. Guidelines from national groups such as the American Society of Anesthesiologists (ASA) and the American Society for Gastrointestinal Endoscopy (ASGE) support using MAC when needed, especially if there are serious health concerns or complex procedures involved.
When is Monitored Anesthesia Care Clinically Appropriate?
MAC may be appropriate in these situations:
When is this not Clinically Appropriate?
MAC is not appropriate for people who do not meet the conditions listed above. Studies show that standard sedation is generally safe for most people undergoing GI endoscopy. In these cases, the use of anesthesia providers (like an anesthesiologist or nurse anesthetist) during routine GI procedures is also not considered medically necessary. MAC should only be used when there is a clear medical reason based on the person’s health or the complexity of the procedure. Using MAC when it is not needed may not provide added safety or benefit.
| Coding |
The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.
When services may be Medically Necessary when criteria are met:
| CPT |
|
| 00731 |
Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified |
| 00732 |
Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP) |
| 00811 |
Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified |
| 00812 |
Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy |
| 00813 |
Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum |
|
|
|
| ICD-10 Diagnosis |
|
|
|
All diagnoses |
When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met or for situations designated in the Clinical Indications section as not medically necessary.
| Discussion/General Information |
Summary
Monitored anesthesia care (MAC) is appropriate for certain gastrointestinal (GI) endoscopic procedures, including higher-risk scenarios such as therapeutic or prolonged procedures, severe systemic disease, difficult airway anatomy, extremes of age, pregnancy, or prior sedation intolerance. Supporting literature demonstrates low complication rates for sedation overall and comparable safety between moderate sedation and MAC in selected high-risk settings. Current recommendations align with American Society of Anesthesiologists (ASA) and the American Society for Gastrointestinal Endoscopy (ASGE), which advise anesthesia-provider involvement for complex or high-risk procedures and underscore readiness to manage deeper sedation levels. Recent ASA updates (2023-2024) reaffirm MAC as a defined anesthesia service and include new guidance on respiratory monitoring and sedation continuum definitions.
Discussion
Anesthesia services include all services associated with the administration and monitoring of analgesia or anesthesia to an individual in order to produce partial or complete loss of sensation. Examples of various methods of anesthesia include moderate sedation (“conscious sedation”), MAC, regional anesthesia and general anesthesia.
Adequate sedation and analgesia is an integral part of a diagnostic or therapeutic GI procedure. Sedation may be defined as a drug-induced depression in the level of consciousness. The purpose of sedation and analgesia is to relieve an individual’s discomfort and anxiety, improve the outcome of the examination and diminish the individual’s memory of the event. The choice of sedative used during procedures is operator dependent.
Paspatis and colleagues (2011) reported on 520 individuals undergoing colonoscopy for the detection of polyps and were randomized to either deep sedation (n=258) or moderate sedation (n=262) with the hypothesis that deep sedation may increase the rate of polyp detection compared to moderate sedation which would enhance the quality of the colonoscopy. The degree of sedation was assessed by a research nurse using the modified observer’s assessment of alertness/sedation (MOAA/S) scale. Each participant’s satisfaction with the sedation was assessed 2 hours after the procedure in the recovery area. The endoscopist’s satisfaction concerning the sedation during the procedure was also assessed immediately following the procedure. There was no difference between the 2 groups in regard to the overall rate of polyps detected. There was no difference in the level of participant satisfaction between the 2 groups. However, the endoscopist’s satisfaction rating was greater in the deep sedation group compared to the moderate sedation group.
In a 2018 study by Behrens and colleagues, the authors reported on sedation-assisted complications during GI endoscopic procedures. A total of 368,206 endoscopies were recorded; 11% were without sedation. Of the individuals who received sedation, 38 suffered a major complication with overall mortality 0.005% and minor complications occurred in 0.3%. Across 39 facilities, when compared with hospitals, tertiary referral centers had higher complication rates. Also of note is that when another person (nurse or physician) was added to provide sedation during a two-person endoscopy team (endoscopist/assistant), a higher complication rate occurred. The authors note that this higher complication rate could have been attributed to a higher complexity of the procedure. Overall sedation-related complications during GI endoscopy procedures are rare with a very low mortality rate.
In a 2019 retrospective cohort study by Edelson and colleagues, the authors examined the safety of moderate sedation and MAC in individuals with cirrhosis. The primary outcome was safety, defined as the absence of adverse events. In a cohort of 2618 participants, 1157 underwent MAC anesthesia and 1461 underwent benzodiazepine/narcotic-based moderate sedation. The participants in the MAC group had less severe liver disease compared to the moderate sedation group as evidenced by higher Model for End-Stage Liver Disease (MELD) and Child-Pugh scores, a higher prevalence of ascites, and more frequent hepatic encephalopathy. The individuals who received moderate sedation had higher ASA scores and Charlson Comorbidity Index (CCI) severity scores. Esophagogastroduodenoscopy (EGD) was performed most commonly, 679 of the 1157 (58.7%) participants in the MAC group which was comparable to 988 of the 1461 (67.6%) participants in the moderate sedation group. Other procedures included endoscopic ultrasound and/or ERCP, colonoscopy, percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy placement, flexible sigmoidoscopy, and ileoscopy. There were 15 adverse events overall, 7 in the MAC group and 8 in the moderate sedation group. Hypoxia was the most common adverse event followed by bleeding and hypotension. The authors note that moderate sedation appears to be as safe as MAC in persons with cirrhosis. Limitations of the study include its retrospective design, provider discretion regarding which individuals received MAC or moderate sedation, and possible ascertainment bias in the assignment of ASA scores which were assigned by different providers.
Smith and colleagues (2019) reported on a randomized controlled trial which evaluated safety of general anesthesia compared to propofol-based MAC in individuals undergoing ERCP. Eligible participants had planned ERCP and at least one established risk factor for sedation-related adverse events. A 1:1 randomization was performed in the preprocedure area and all participants were sedated by 1 of 5 nurse anesthetists under the direction of an anesthesiologist. ERCP was performed by 1 of 4 experienced interventional endoscopy attending physicians. Ultimately 200 individuals completed the study and were included in the analysis; 101 in the general anesthesia arm and 99 in the MAC arm. Sedation-related adverse events included hypoxemia, the use of airway maneuvers, conversion to general anesthesia, hypotension requiring vasopressors, sedation-related procedure interruption or termination, cardiac arrhythmia, and respiratory failure. In the MAC group, 51 of 99 (51.5%) individuals experienced a sedation-related adverse event compared to 10 of 101 (10%) in the general anesthesia group, primarily based on the incidence of hypoxemia and the need for airway maneuvers such as nasal airway, oral airway, chin lift, jaw thrust, or bag max ventilation. In the MAC group there were 45 airway maneuvers used with a total of 19 participants who experienced hypoxemia compared to none in the general anesthesia group. The results of this study may not be generalizable. While the results suggest that general anesthesia is the preferred method for those undergoing ERCP who are at high risk for sedation-related adverse events, it should be noted that the use of airway maneuvers were defined as sedation-related adverse events. Other institutions may consider airway maneuvers a standard part of maintaining a patent airway during MAC and should not be classified as a sedation-related adverse effect. The nurse anesthetists in this study were very experienced in sedating individuals for ERCP. There may be limitations for anesthesia providers in other facilities. Larger sample sizes at multiple facilities may be necessary to generalize results.
The American College of Gastroenterology (ACG) released a Position Statement (Vargo, 2009) which recommends that “the use of anesthesiologist-administered sedation for healthy, low-risk patients undergoing routine GI endoscopy results in higher costs with no proven benefit with respect to patient safety or procedural efficacy.”
The ASA Statement on Distinguishing Monitored Anesthesia Care ("MAC") from Moderate Sedation/Analgesia (Conscious Sedation) (2023) states:
The American Society of Anesthesiologists has defined Monitored Anesthesia Care (MAC) as a specific anesthesia service performed by a qualified (trained) anesthesia provider, for a diagnostic or therapeutic procedure. Indications for MAC include, but are not limited to, the nature of the procedure, the patient’s clinical condition and/or the need for deeper levels of analgesia and sedation than can be provided by moderate sedation (including potential conversion to a general or regional anesthetic). Monitored anesthesia care includes all aspects of anesthesia care - a preprocedure assessment and optimization, intraprocedure care and postprocedure management that is inherently provided by a qualified anesthesia provider as part of the bundled specific service. During MAC, the anesthesiologist provides or medically directs a number of specific services, including but not limited to:
MAC may include varying levels of sedation, awareness, analgesia and anxiolysis as necessary. The qualified anesthesiologist provider of monitored anesthesia care must be prepared to manage all levels of sedation up to and including general anesthesia and respond to the pathophysiology (airway and hemodynamic changes) of procedure and patient positioning.
In 2018, the ASGE released Guidelines for Sedation and Anesthesia in GI endoscopy and stated that individuals with medical comorbidities may require MAC. Many factors go into determining whether the assistance of MAC is necessary. Risk factors include:
Significant medical conditions such as extremes of age; severe pulmonary, cardiac, renal, or hepatic disease; pregnancy; the abuse of drugs or alcohol; uncooperative patients; a potentially difficult airway for positive-pressure ventilation; and individuals with anatomy that is associated with more difficult intubation.
The guideline also lists situations when anesthesia provider assistance should be consulted to provide sedation. These situations include:
Individuals at Risk for Malignant Hyperthermia
Malignant hyperthermia (MH) is an inherited skeletal-muscle disorder most commonly linked to pathogenic variants in the RYR1 gene, and less frequently in CACNA1S and STAC3. MH predisposes individuals to a hypermetabolic crisis following exposure to volatile anesthetics or succinylcholine. Although MH often presents without overt muscle disease, certain congenital myopathies such as central core disease, multiminicore myopathy, congenital fiber-type disproportion, centronuclear myopathy, and King-Denborough syndrome are associated with RYR1 variants and therefore confer elevated risk. Family or personal history of MH-like reactions, unexplained peri-anesthetic hyperthermia, rhabdomyolysis after exercise or heat exposure, or persistently elevated serum creatine kinase may also indicate susceptibility. Because phenotypic expression varies widely even within families carrying the same variant, risk evaluation should integrate genetic testing when available, contracture testing in specialized centers, and careful review of family history (Litman, 2018).
The greatest risk for MH occurs with administration of volatile anesthetic agents such as halothane, isoflurane, sevoflurane, and desflurane with or without coadministration of succinylcholine (Larach, 2010). Rüffert and colleagues (2021) also recommend avoiding triggering volatile inhalational anesthetics and succinylcholine. Their conclusions were based on the Grading of Recommendation, Development and Evaluation (GRADE) system. Most of their recommendations were GRADE 1c which means they were strongly recommended, had low-quality of evidence and were of high clinical importance and consensus. They did not provide specific recommendations for MAC usage, nor did they cite a preference of MAC over other anesthesia methods. The previously mentioned 2018 ASGE Guideline for Sedation and Anesthesia in GI Endoscopy notes that individuals with medical comorbidities may require MAC or general anesthesia (ASGE, 2018). Accurate identification of such individuals who are at risk for MH allows avoidance of triggering agents and ensures appropriate perioperative preparedness (for example, dantrolene availability, anesthesia-machine flushing, and vigilant temperature and end-tidal CO₂ monitoring) when potentially triggering agents are used.
MH susceptibility alone does not require MAC for GI endoscopy. Individuals with identified MH risk may safely receive moderate or deep sedation using only non-triggering agents in facilities prepared for MH management. MAC should be reserved for cases in which additional comorbidities, airway risk, or procedural complexity justify anesthesiologist involvement.
Pediatric considerations
There is no single age cut-off for individuals in a pediatric age group that would clearly determine an individual to be at higher risk. Several organizations have proposed age cut-offs for monitored sedation ranging from 19 to 21 years and other organizations are silent regarding at what age an individual is no longer considered to be in the pediatric age group. In a 2017 statement by the American Academy of Pediatrics (AAP, Hardin, 2017), it is noted that limits that affect care should not be placed solely based on age but rather take into consideration the physical and psychosocial needs of pediatric members. Typically, by the age of 18, an individual will have finished growing in regard to facial structures and airway size.
In a 2019 retrospective chart review by Najafi and colleagues, the authors determined the prevalence of adverse events during MAC. Children up to age 16 years who underwent elective or diagnostic GI endoscopy were included (n=3435). Children who presented with ASA physical status of at least 4, those who required mechanical ventilation, and those undergoing therapeutic or urgent GI endoscopy were not included in the review. There were 64% of children with ASA physical status of 1 or 2 and 36% with ASA 3. The comorbid breakdown is as follows: respiratory comorbidities (n=1299), recent respiratory infection (n=799), both respiratory comorbidity and infection (n=736), psychological disorders (n=605), neurological comorbidities (n=505), history of prematurity (n=219), and congenital cardiac abnormalities (n=106). Upper GI endoscopy, with or without lower GI endoscopy, was performed in 87.1% of children. There were 116 overall adverse events, including 113 adverse respiratory events reported, with 55 documented as minor, 58 as intermediate and 3 as sentinel events. MAC failed in 11 children. An unplanned tracheal intubation was necessary for 3 sentinel events (apnea and severe laryngospasm). Review of the charts showed 19 potential predictors found to be significantly associated with the occurrence of adverse events, which included ASA physical status; age; weight; height; children’s size; the presence of respiratory comorbidities, or recent respiratory infection, or both; neurological comorbidities; history of prematurity; psychological disorders; gastroesophageal reflux disease; allergy to food; upper versus lower GI endoscopy; respiratory reason for endoscopy with or without GI problems; induction dose of propofol; induction dose of ketamine; co-administration of ketamine and propofol and propofol administration after sevoflurane induction. This chart review showed very few sedation-related adverse effects, with the exception of adverse respiratory events. The study limitations include the retrospective design and single-center nature which could reduce generalizability of the results. There may have been minor interventions performed by anesthesiology staff such as airway positioning that may not have been documented, leading to underreporting of minor adverse events.
Anesthesia services are provided by or under the supervision of a physician. Services consist of the administration of an anesthetic agent in conjunction with physiologic monitoring in various types of anesthesia services.
| Definitions |
General Anesthesia: A reversible state of unconsciousness and the inability to perceive pain, produced by anesthetic agents, with absence of pain sensation over the entire body and a greater or lesser degree of muscular relaxation; the drugs producing this state can be administered by inhalation, intravenously, intramuscularly, rectally, or via the gastrointestinal tract.
Moderate Sedation: Involves the administration of medication with or without analgesia to achieve a state of depressed consciousness while maintaining the individual's ability to respond to stimulation. Moderate sedation is administered by the surgeon or physician performing the procedure or an independent trained practitioner for the purpose of assisting the physician in monitoring the individual's level of consciousness and physiological status. It includes pre- and post- sedation evaluations, administration of the sedation and monitoring of the cardiorespiratory function. Cardiorespiratory functions monitored include heart rate, blood pressure and oxygen level.
Monitored Anesthesia Care (MAC)*: MAC was developed in response to the shift to providing more surgical and diagnostic services in an ambulatory, outpatient or office setting without the use of the traditional general anesthetic. Accompanying this, there has been a change in the provision of anesthesia services from the traditional general anesthetic to a combination of local, regional and certain conscious altering drugs. This type of anesthesia is referred to as MAC if directly provided by anesthesia personnel. Based on the ASA’s standards for monitoring, MAC should be provided by qualified anesthesia personnel (anesthesiologists or qualified anesthetists such as CRNA). These personnel must be continuously present to monitor the individual and provide anesthesia care.
American Society of Anesthesiologists Levels of Sedation/Analgesia (2019)
Minimal Sedation (Anxiolysis): is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.
Moderate Sedation/Analgesia (“Conscious Sedation”): is a drug-induced depression of consciousness during which patients respond purposefully** to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
Deep Sedation/Analgesia: is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully** following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
American Society of Anesthesiologists Definition of General Anesthesia (2019)
General Anesthesia: is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue*** patients whose level of sedation becomes deeper than initially intended. Individuals administering Moderate Sedation/Analgesia (“Conscious Sedation”) should be able to rescue*** individuals who enter a state of Deep Sedation/Analgesia, while those administering Deep Sedation/Analgesia should be able to rescue*** patients who enter a state of General Anesthesia.
*Monitored Anesthesia Care (MAC) does not describe the continuum of depth of sedation, rather it describes “a specific anesthesia service performed by a qualified anesthesia provider, for a diagnostic or therapeutic procedure.” Indications for monitored anesthesia care include “the need for deeper levels of analgesia and sedation that can be provided by moderate sedation (including potential conversion to general or regional anesthetic).”
**Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.
***Rescue of an individual from a deeper level of sedation than intended is an intervention by a practitioner proficient in airway management and advanced life support. The qualified practitioner corrects adverse physiologic consequences of the deeper-than-intended level of sedation (such as hypoventilation, hypoxia and hypotension) and returns the patient to the originally intended level of sedation. It is not appropriate to continue the procedure at an unintended level of sedation.
| References |
Peer Reviewed Publications:
Government Agency, Medical Society, and Other Authoritative Publications:
| Index |
Anesthesia Services
Gastrointestinal Endoscopic Procedures
Monitored Anesthesia Care
| History |
| Status |
Date |
Action |
| Reviewed |
02/19/2026 |
Medical Policy & Technology Assessment Committee (MPTAC) review. Added “Summary for Members and Families” section. Revised Description, Discussion/General Information, and References sections. |
| Reviewed |
02/20/2025 |
MPTAC review. Revised Discussion and References sections. |
| Reviewed |
02/15/2024 |
MPTAC review. Updated Discussion/General Information and References sections. |
| Reviewed |
02/16/2023 |
MPTAC review. Updated References section. |
| Reviewed |
02/17/2022 |
MPTAC review. Updated References section. |
| Reviewed |
02/11/2021 |
MPTAC review. Updated Discussion/General Information and References sections. Reformatted Coding section. |
| Reviewed |
02/20/2020 |
MPTAC review. Updated Discussion/General Information and References sections. |
| Reviewed |
03/21/2019 |
MPTAC review. Updated Discussion/General Information and References sections. |
| Reviewed |
03/22/2018 |
MPTAC review. Updated Discussion/General Information and References sections. |
|
|
12/27/2017 |
The document header wording updated from “Current Effective Date” to “Publish Date.” Updated Coding section with 01/01/2018 CPT changes; added codes 00731, 00732, and 00811-00813; removed 00740 and 00810 deleted 12/31/2017. |
| Reviewed |
05/04/2017 |
MPTAC review. Updated Description, Discussion/General Information, References and Index sections. |
| Reviewed |
05/05/2016 |
MPTAC review. Removed ICD-9 codes from Coding section. |
| Reviewed |
05/07/2015 |
MPTAC review. Updated Discussion/General Information, Definitions, and References. |
| Revised |
05/15/2014 |
MPTAC review. Clarification to Clinical Indications section about prolonged or therapeutic endoscopic procedure and clarification about anticipated intolerance to sedatives. Updated Discussion/General Information and References. |
| Revised |
05/09/2013 |
MPTAC review. Clinical Indication statement edited to allow operating physician or the anesthesiologist to provide documentation about higher risk situations. Updated References. |
| Revised |
11/08/2012 |
MPTAC review. Updated Description and Index. Title change to “Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures.” Updated Clinical Indications to remove statement for moderate sedation. Added medically necessary statement for anesthesiologist and CRNA. Added not medically necessary statement for when criteria are not met. Updated Coding section; removed 99143, 99144, 99145, 99148, 99149, 99150 no longer applicable. |
| Reviewed |
08/09/2012 |
MPTAC review. Updated Discussion/General Information and References. Added Definitions section. Updated Coding section to remove anesthesia modifiers, and non-specific CPT codes related to epidural anesthesia, nerve blocks and risk factors. |
| Revised |
08/18/2011 |
MPTAC review. Updated Clinical Indications to define “pediatric age group” as those individuals under the age of 18. Updated Discussion/General Information and References. |
| Reviewed |
08/19/2010 |
MPTAC review. Updated Discussion/General Information and References. |
| Reviewed |
08/27/2009 |
MPTAC review. Removed “Place of Service” section. Updated References. |
| Reviewed |
08/28/2008 |
MPTAC review. Updated References and Web Sites. |
| Revised |
08/23/2007 |
MPTAC review. Clarification of medically necessary criteria documentation. References updated. |
| Reviewed |
05/17/2007 |
MPTAC review. References updated. |
| New |
06/08/2006 |
MPTAC initial document development. Original document part of CG-MED-21 Anesthesia Services and Moderate Sedation. |
| Appendix |
American Society of Anesthesiology Physical Status Classifications:
Class I: A normal healthy patient
Class II: A patient with mild systemic disease
Class III: A patient with severe systemic disease
Class IV: A patient with severe systemic disease that is a constant threat to life
Class V: A moribund patient who is not expected to survive without the operation
Class VI: A declared brain-dead patient whose organs are being removed for donor purposes
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