Victory: BCBSMA Rolls Back Restrictive Anesthesia Policy

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, therefore, no claims will be rejected for payment. (Read policy update)

This decision follows intense advocacy efforts by American Society of Anesthesiologists (ASA), bringing together a coalition that included the GI societies (American Society for Gastrointestinal Endoscopy (ASGE) and American Gastroenterological Association (AGA)) and the American College of Surgeons (ACS), with the Massachusetts Gastroenterology Association and the Massachusetts Society of Anesthesiologists (MSA), 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 the 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.