Special Edition Newsletter: Moderate Sedation

Revision to 'Professional Billing of Moderate Sedation by the Physician Performing the Procedure When in a Facility Site of Service'

The codes for reporting moderate sedation performed by a physician or other qualified health care professional other than the one performing the procedure do not have different RVUs for the facility and non-facility sites of service. The RVUs are the same. There is also an NA in the NON-FAC NA INDICATOR column of the RVU file. From the CMS document explaining the NA in this field: An “NA” in this field indicates that this procedure is rarely or never performed in the non-facility setting.

Original Article (from January 20, 2017):

In the physician RVU file there is a column labeled “PCTC IND” which designates when a code is technical-only or professional-only. The add-on code for each additional 15 minutes of moderate sedation by the physician performing the procedure (99153) is indicated as technical-only (3) in this field. In addition, there is an NA in the RVU file column titled “FACILITY NA INDICATOR”. The NA indicates “that this procedure is rarely or never performed in the facility setting”. Since code 99153 is technical only, a physician cannot report this code when performed in the facility setting. 

The other moderate sedation codes (99151, 99152, 99155, 99156, and 99157) are assigned a “9” indicating the TC/PC concept doesn’t apply; there are different RVU values for facility and non-facility site of service. The NA is not in the “FACILITY NA INDICATOR” column for these other codes.

When a physician performing the procedure oversees moderate sedation in the facility setting, only a code describing the initial 15 minutes of sedation (99151 or 99152) may be reported when billing for the physician. The hospital may bill 99153 when documented (MUE is 9). The physician must still document all the required components of the moderate sedation as detailed in the CPT codebook.