CG-MED-34

Monitored anesthesia care is covered for gastrointestinal endoscopic procedures when deemed medically necessary, particularly for patients with specific high-risk factors such as age, medical history, or behavioral concerns. Key requirements include thorough documentation of the patient's medical history and the necessity for deeper sedation. However, this coverage is limited to cases where local anesthesia is inadequate, and it does not apply to procedures not approved by the payer, nor does it cover anesthesia billing.

"Monitored anesthesia care is covered for gastrointestinal endoscopic procedures when deemed medically necessary."

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