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March 16, 2017 - Updated 04.08.19

Clarification of CPT Code 99153

Code Descriptor: Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intraservice time (list separately in addition to code for primary service)

Billing for moderate sedation services (CPT Codes 99151 or 99152) represents the first 15 minutes of service. All physician work occurs during that first 15 minutes. Usually thereafter, the physician is engaged in performing the procedure, and a nurse will monitor the patient.

CPT 99153 has no physician work associated with it and is therefore a technical component only code (PC/TC indicator 3). When billed in a facility setting it is not payable to the physician but may be paid to the facility. When billed in the office it is payable to the physician.

CMS assigned this code a Professional/Technical Component (PCTC) indicator "3" effective for dates of service on or after January 1, 2017, per Change Request 9780 (Change Request 9780). Technical components are not separately payable when performed by a physician in a facility setting because the facility has staff on hand to perform those services.

Reference: CR 9780screenshot

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