CG-MED-34 Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures

This policy addresses monitored anesthesia care (MAC) for gastrointestinal endoscopic procedures. MAC is medically necessary only when the operating physician or anesthesiologist documents a higher-risk indication, such as a prolonged/therapeutic procedure requiring deep sedation (e.g., ERCP or repeat colonoscopy for a tortuous colon), a history or anticipated poor response to standard moderate-sedation agents due to cross-tolerance or paradoxical reaction, or severe comorbidity (ASA class III or higher). MAC is not medically necessary when these criteria are not met, and routine anesthesiologist/CRNA involvement for endoscopy without these indications is not covered.

"Monitored Anesthesia Care (for definition, see Discussion below)"

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