99143
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- General Anesthesia or Regional AnesthesiaAdministration of general or regional anesthesia is consideredmedically necessarywhen both of the following criteria are met:
- The services are provided by an individual other than the attending physician performing the procedure;and
- Alternative types of anesthesia, sedation, or analgesia are not appropriate.
- If general or regional anesthesia is requested for a procedure typically not requiring either of these levels of anesthesia service, a medical necessity review will be performed. This review will assess not only the procedure involved, but also other individual-specific issues, such as age, mental status, ability to cooperate, co-morbid conditions, and general medical status.
- Monitored Anesthesia Care (MAC)Monitored anesthesia care (MAC) is consideredmedically necessarywhenallof the following criteria are met:
- MAC is requested by the attending physician;and
3 Active Policies
ANTHEM-CG-MED-21 — CG-MED-21 Anesthesia Services and Moderate (âConsciousâ) Sedation
ANTHEM-CG-MED-41 — CG-MED-41 Moderate to Deep Anesthesia Services for Dental Surgery in the Facility Setting
ANTHEM-CG-MED-34 — CG-MED-34 Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.