Conscious sedation versus MAC for colonoscopy and GI endo

hildebjlhildebjl
in COVERAGE

As we recruit specialty providers for GI, we often receive feedback that the provider has been performing colonoscopies using only MAC and not conscious sedation. The ask is that all colonoscopies be performed with MAC.

Most of our contracted payers have well defined, strict parameters on when MAC is payable for colonoscopies and other GI procedures, so it is very difficult to clear medical necessity if we'd like to use MAC rather than conscious sedation.

I'm interested in how other organizations are handling this situation. We could certainly offer it to the patient at their cost, but it's unlikely that most patients would pay out of pocket.

Has your organization successfully negotiated payer contract terms to allow MAC for these procedures? Are you working more diligently to get patients qualified for MAC based on co-morbities?

Appreciate your feedback.

Comments

  • CZNANIECCZNANIEC

    I would challenge the payers with medical research and the trend towards MAC in this space.

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