Moderate sedation
- Usually given by the physician doing the procedure, or a nurse under their direction
- Billed with moderate sedation codes, based on time, with separate codes depending on who gives it and the patient's age
- Paid much less than anesthesia
Monitored anesthesia care
- Given by an anesthesia provider, such as a CRNA or anesthesiologist
- Billed with anesthesia codes, base units plus time
- The provider must be ready to convert to general anesthesia
Why it matters
A payer won't pay for both on the same case. If a claim for MAC looks like moderate sedation work, or the record doesn't show an anesthesia provider was managing the patient, expect a denial. Keep a full anesthesia record for every MAC case, with a pre-anesthesia assessment, monitoring and times.
More in our MAC billing guide.
This article is general information, not billing, legal or tax advice. Payer rules change; always check current guidance.