Indiana Health Coverage Plans (IHCP) recently announced they will unbundle conscious sedation from approximately 400 procedure codes and begin reimbursing providers separately for the conscious sedation.
In line with 2017 CPT Coding changes which were implemented into the Medicare program back in January, Indiana Medicaid will use the following codes to reimburse providers for conscious sedation beginning September 15, 2017, when used with the procedures codes listed in the table published in this bulletin:
- 99155: “initial 15 minutes of intraservice time, patient younger than 5 years of age”
- 99156: “initial 15 minutes of intraservice time, patient age 5 years or older”
- 99157: “each additional 15 minutes intraservice time (list separately in addition to code for primary service)”
According to a Physicians’ Practice article discussing the code changes, CPT guidelines for the new conscious sedation codes include a minimum time requirement of 10 minutes to report moderate sedation (99155 and 99156) and at least seven minutes to report an additional unit (99157).
While the list of unbundled codes includes primarily surgical procedures, some procedures occasionally performed in the emergency department also are included, like chest tube placement and elective cardioversion.
These payment policy changes affect all fee-for-service Medicaid programs, according to IHCP Bulletin 201753, but managed care entities (MCEs) may establish and publish unique billing guidance related to these services.
For more information, refer to IHCP Bulletin 201753.
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