Victory: BCBSMA Rolls Back Restrictive Sedation Policy

American College of Gastroenterology. American Gastroenterological Association. American Society For Gastrointestinal Endoscopy.

In a significant victory in our collective efforts to safeguard patient choice and healthcare standards, Blue Cross Blue Shield of Massachusetts (BCBSMA) officially postponed its restrictive sedation policy until further notice! This change is retroactive to Jan. 1, 2024, so no claims will be rejected for payment. (Read policy update) 


This decision follows intense advocacy efforts by our societies, bringing together a coalition that included the American Society of Anesthesiologists (ASA) and the American College of Surgeons (ACS), with the Massachusetts Gastroenterology Association demonstrating exceptional leadership and perseverance throughout the process.  

We are grateful that BCBSMA ultimately heeded our warnings about the potential impact on cancer screening access and patient choice in GI care. 

Physician leaders representing our societies played a crucial role in meetings with BCBSMA, contributing to this positive outcome. Member engagement, including contacting legislators, media outreach, and participation in the #Noto154 campaign, had a substantial impact. 

How to code 

BCBSMA informed us that all claims will be paid; however, documentation will still be required for patients presenting with ASA 1 and ASA 2. Download a list of commonly used diagnosis codes documented with the administration of propofol. We hope you find this list useful and encourage you to still be mindful that BCBSMA will be monitoring the use of these codes for propofol administration. See BCBSMA policy 154 for the complete list of diagnosis codes that support use of MAC. Our societies have requested that BCBSMA provide education to providers on this requirement.

While celebrating this victory, we remain vigilant -- in closely monitoring developments to ensure similar policies are not introduced nationally. Stay tuned for further updates.
 
Thank you to everyone, including patient advocacy groups involved, for being an essential part of this achievement. 

About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with almost 16,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit Asge.org and ValueOfColonoscopy.org for more information and to find a qualified doctor in your area.

 

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Media Contact

Andrea Lee
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ALee@asge.org