Does Medicare Cover Anesthesia?
Original Medicare covers most of the costs of anesthesia services. You may still be responsible for a portion of the Medicare-approved costs, and you may have to pay an additional copayment to the facility. Anesthesia for a colonoscopy to screen for colon cancer is fully covered by Medicare.
Medicare Coverage for Anesthesia
Original Medicare — Medicare Part A and Part B — covers most of the costs for anesthesia services so long as they are associated with a Medicare-covered medical or surgical service.
Medicare spent about $2 billion on anesthesia services for Medicare beneficiaries in 2018, according to the Government Accountability Office.
- Medicare Part A hospital insurance
- Medicare Part A covers anesthesia services if you are an inpatient at a hospital — meaning you have been formally admitted to the hospital.
- Medicare Part B medical insurance
- Medicare Part B covers anesthesia services you receive in an outpatient setting. This includes procedures you may receive in a hospital outpatient department or in a freestanding ambulatory surgical center.
Medicare Advantage plans are required by law to cover everything Medicare Part A and Part B covers, but they may also provide additional benefits beyond Original Medicare coverage. Medicare Advantage plans are sold by private insurers and benefits vary from plan to plan.
If you have a Medicare Advantage plan, you may have to use an anesthesiologist within your plan’s network to avoid additional costs.
Your Costs for Anesthesia If You Have Medicare
You have to pay 20 percent of the Medicare-approved cost for anesthesia provided by a doctor or certified registered nurse anesthetist. You also have to pay your Medicare Part B deductible if your anesthesia services are provided in an outpatient setting.
You are also responsible for any additional copayment charged by the facility where you received your procedure.
A Medigap — Medicare Supplement insurance — policy can help you cover out-of-pocket costs. These are policies sold by private insurers that can be used to help pay your deductibles, coinsurance and copayments that Original Medicare does not cover.
Does Medicare Cover Conscious Sedation?
Conscious sedation for eligible surgeries and other procedures is covered by Medicare Part B medical insurance. Your out-of-pocket costs apply as with other types of anesthesia services.
Conscious sedation is typically used for dental procedures that Medicare may not cover, such as routine cleanings. But it’s also used for endoscopies and minor surgical procedures that Medicare does cover.
Also called moderate sedation or analgesia, conscious sedation is a drug-induced state during which a patient can respond to verbal commands and still has a sense of touch, according to the American Society of Anesthesiologists.
Under conscious sedation, you don’t need help breathing, and you can typically maintain cardiovascular function on your own. This compares with general anesthesia during which you can’t be aroused even with painful stimulus, you may need help breathing, and your cardiovascular function may be impaired.
Medicare and Anesthesia for Colonoscopies
Medicare Part B covers the full cost of anesthesia services for a colonoscopy if it is to screen for colon cancer, which is a Medicare-covered condition. The doctor must accept Medicare, and the procedure must be for colon cancer screening purposes only.
If the doctor removes polyps or other tissue during the procedure, Medicare considers the colonoscopy a treatment rather than a preventive service, and you will have to pay out-of-pocket costs for anesthesia and other aspects of the procedure.
Medicare may not pay for anesthesia if the colonoscopy is for the purpose of diagnosing other symptoms or conditions. This includes colonoscopies ordered to diagnose gastrointestinal disorders or symptoms including diarrhea, bloating or blood in your stool.
5 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2021, January 1). Chapter II; Anesthesia Services CPT Codes 00000-01999. Retrieved from https://www.cms.gov/files/document/chapter2cptcodes00000-01999final112021.pdf
- U.S. Government Accountability Office. (2020, October 26). Anesthesia Services: Differences Between Private and Medicare Payments Likely Due to Providers’ Strong Negotiating Position. Retrieved from https://www.gao.gov/products/gao-21-41
- American Society of Anesthesiologists. (2019, October 23). Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Retrieved from https://www.asahq.org/standards-and-guidelines/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedationanalgesia
- Anesthesia Business Consultants. (2014, December 8). Medicare Eliminates Patient Cost-Sharing for Anesthesia for Screening Colonoscopies. Retrieved from https://www.anesthesiallc.com/publications/anesthesia-provider-news-ealerts/724-medicare-eliminates-patient-cost-sharing-for-anesthesia-for-screening-colonscopies
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Anesthesia. Retrieved from https://www.medicare.gov/coverage/anesthesia