Moderate Sedation CPT 99151, CPT 99152 & CPT 99153 | Descriptions & Guidelines
CPT 99151 can be billed for moderate sedation services for children younger than 5 years, CPT 99152 for moderate sedation services for patients older than 5 years for the first 30 minutes and CPT 99153 is an add-on code for every 15 minutes of additional time.
Click on a link to go to that section of the article.
- What Is Moderate Sedation?
- Billing Guidelines
- General Guidelines
- CPT Code 99151
- CPT Code 99152
- CPT Code 99153
1. What Is Moderate Sedation?
Moderate sedation services are provided by the same physician performing the diagnostic or therapeutic service. This requires the presence of an independent trained observer to assist in the monitoring of a patient.
2. Billing Guidelines
Claims for moderate sedation should be submitted hard copy indicating the medical necessity for the procedure. Documentation should also reflect pre- and post-sedation clinical evaluation of the patient.
Moderate sedation does not include minimal sedation (anxiolysis), deep sedation or monitored anesthesia care (CPT 00100 – CPT 01999).
Moderate sedation is restricted to recipients from birth to age 13. (Exceptions to the age restriction will be made for children who are severely developmentally disableddocumentation attached must support this condition. No claims will be considered for recipients twenty-one years of age or older)
Moderate sedation includes the following services (which are not to be reported/billed separately):
Assessment of the patient (not included in intraservice time);
- establishment of IV access and fluids to maintain patency, when performed;
- maintenance of sedation;
- administration of agent(s);
- recovery (not included in intraservice time); and
- monitoring of oxygen saturation, heart rate and blood pressure.
2.1 Louisiana Medicaid
Louisiana Medicaid has adopted Procedure guidelines for procedures that include moderate sedation as an inherent part of providing the procedure.
Louisiana Medicaid does not reimburse when a second physician other than the health care professional performing the diagnostic or therapeutic service provides the sedation. Claims paid inappropriately are subject to recoupment.
3. General Billing Guidelines
Report CPT 99151 for Moderate Sedation of patients younger than 5 years old, CPT 99144 for patients of 5 years or older and CPT 99145 can be reported for every additional 15 minutes of moderate sedation services.
4. CPT Code 99151
CPT code 99151 is described by the CPT manual as: “Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age.”
4.1 Procedure
The goal of CPT 99151 procedure is to administer medication to reduce consciousness in a child younger than five years of old.
The provider performing a diagnostic or therapeutic procedure administers one or more drugs to reduce the patient’s level of consciousness (awareness of surrounding environment) in the presence of an independent trained observer.
He asks the patient to react purposefully to verbal commands. The provider administers further doses of the drugs as required.
He monitors the patient until the end of the procedure. He ensures the patient’s condition is stable at that time.
4.2 Billing Guidelines
Report 99151 in combination with 99153 for each additional 15 minutes of moderate sedation.
Report CPT 99152 instead of CPT 99151 for the same service for a patient five years of age or older.
5. CPT Code 99152
CPT code 99152 is described by the CPT manual as: “Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older.”
5.1 Procedure
The goal of CPT 99152 procedure is to administer medication to reduce consciousness in a patient of five years or older.
The provider performing a diagnostic or therapeutic procedure administers one or more drugs to reduce the patient’s level of consciousness (awareness of surrounding environment) in the presence of an independent trained observer.
He asks the patient to react purposefully to verbal commands. The provider administers further doses of the drugs as required. He monitors the patient until the end of the procedure. He ensures the patient’s condition is stable at that time.
5.2 Billing Guidelines
Report add-on code 99153 together with CPT 99152 for each additional 15 minutes of moderate sedation.
The same service for a patient younger than five years of age can be reported with CPT 99151.
6. CPT Code 99153
CPT code 99153 is described by the CPT manual as: “Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes intraservice time (List separately in addition to code for primary service).”
6.1 Procedure
This is an add-on code. This code is already described in the procedure section of CPT code 99152.
6.2 Billing Guidelines
CPT code 99153 is an add-on code and can only be reported in conjunction with CPT 99151 and CPT 99152.
