Who is affected by this change?

This affects Blue Cross & Blue Shield of Mississippi Gastroenterology, Anesthesiology providers in MS on All Plans plans.

What do I need to do?

Immediately: Billing team must ensure proper documentation from both endoscopist and anesthesiologist when billing for monitored anesthesia care during GI endoscopy procedures. Verify patient meets at least one specified risk factor (ASA III+, BMI >40, documented sleep apnea, age 70, cognitive dysfunction, spasticity, chronic opioid/benzodiazepine use, pregnancy, substance abuse, airway obstruction risk, or prolonged therapeutic procedures). Claims for MAC without documented qualifying conditions will be denied as not medically necessary.

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Monitored Anesthesia Care during Gastrointestinal Endoscopy

Blue Cross & Blue Shield of Mississippi·MS · Gastroenterology, Anesthesiology·Medical Policy

Effective date

Not stated

We identified it

Jun 20, 2026

Days to comply

—

Summary

This policy establishes criteria for when monitored anesthesia care (MAC) is medically necessary during gastrointestinal endoscopy procedures. MAC is only covered when specific risk factors are documented by both the endoscopist and anesthesiologist, including ASA class III or higher, morbid obesity (BMI >40), sleep apnea, cognitive dysfunction, or patients under 18 or over 70 years old.

Action Required

Action needed

Immediately: Billing team must ensure proper documentation from both endoscopist and anesthesiologist when billing for monitored anesthesia care during GI endoscopy procedures. Verify patient meets at least one specified risk factor (ASA III+, BMI >40, documented sleep apnea, age <18 or >70, cognitive dysfunction, spasticity, chronic opioid/benzodiazepine use, pregnancy, substance abuse, airway obstruction risk, or prolonged therapeutic procedures). Claims for MAC without documented qualifying conditions will be denied as not medically necessary.

Related policy hubs

Blue Cross & Blue Shield of Mississippi policies MS policy changes Gastroenterology Anesthesiology