Payment evolution for endoscopic anesthesia — 4 key phases

Payment policy for endoscopic anesthesia has evolved over the past four years, and there may still be more changes to come, according to Anesthesia Business Consultants President and CEO Tony Mira.

Four changes to note:

1. CMS began covering anesthesia services for colonoscopies several years ago to encourage Medicare patients to undergo regular screenings. Other health plans followed suit. However, as the volume of services increased, prices fell.

2. In January 2018, the American Medical Association introduced three new codes for endoscopy and began determining the value of endoscopic cases based on the procedure's location.

3. More recently, UCLA Medical Group in Los Angeles and Harvard Pilgrim Health Care in Boston introduced new policies requiring patient preauthorization for endoscopic anesthesia. Under these policies, patients are responsible for anesthesia costs if certain medical criteria aren't met.

4. In the next phase of policy evolution, individual insurance plans may begin implementing stricter guidelines and limiting payments when it comes to endoscopic anesthesia, according to Mr. Mira.

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