Starting January 1, Blue Cross Blue Shield (BCBS) Massachusetts will implement a new policy restricting the coverage of monitored anesthesia for certain gastrointestinal procedures. This change will affect patients undergoing endoscopic, bronchoscopic, or interventional pain procedures. The policy states that the use of monitored anesthesia will not be considered “medically necessary” unless the operating physician or anesthesiologist/certified registered nurse anesthesiologist documents specific risk factors or significant medical conditions.
Patients classified as American Society of Anesthesiologists (ASA) Class I or Class II, meaning they have no or few comorbidities, will no longer receive coverage for monitored anesthesia care for routine screening and diagnostic colonoscopy. Prior authorization will be required for all monitored anesthesia cases in the inpatient setting, and it may also be required in the outpatient setting.
The policy change is based on a study from the American Society for Gastrointestinal Endoscopy published ten years ago. Gastroenterologists and industry specialists in Massachusetts are concerned about the potential nationwide ripple effect of this policy. Dr. Max Tilson, a physician with Integrated GI Consultants, expressed concerns that this policy, if successfully implemented in Massachusetts, could roll out elsewhere, impacting access, efficiency, and acceptance of colonoscopy as a preferred screening tool, especially since anesthesia provided care is commonly used in outpatient endoscopy centers.