CG-MED-21 Anesthesia Services and Moderate (“Conscious”) Sedation

This policy addresses anesthesia services—including general, regional, monitored anesthesia care (MAC), and moderate (“conscious”) sedation—for surgical, diagnostic, and therapeutic procedures. General or regional anesthesia is covered when provided by someone other than the operating physician and when lesser anesthesia/sedation is not appropriate; if requested for procedures that typically don’t require it, a medical-necessity review considers patient-specific factors (age, mental status, cooperation, comorbidities, overall health), and MAC is covered only when all plan criteria are met. Anesthesia services are not covered for all other indications; anesthesia furnished by the surgeon is considered part of the primary procedure (not separately covered), and surgeon-administered general anesthesia is not considered medically appropriate.

"General Anesthesia or Regional AnesthesiaAdministration of general or regional anesthesia is consideredmedically necessarywhen both of the following criteria are met:"