Moderate Sedation Services

Moderate sedation, CPT codes 99151–99153, are services provided by the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports. They require the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status. These codes are billed in increments of 15 minutes and are listed in addition to the primary service.

Denials will occur for CPT code 99153 when performed in a facility place of service (POS) setting. 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.

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. 

Resources

• CMS Internet-Only Manual (IOM), (PDF, 1.82 MB) Medicare Claims Processing Manual, Publication100-04, Chapter 23
• Indicator codes are displayed in the CMS Medicare Physician Fee Schedule Database