Billing and reimbursement for sedation services in the United States

Abstract

Sedation is intended to provide safe and effective administration of drugs to relieve anxiety and reduce pain. The aim of any sedation service is to maximize patient comfort, while monitoring the patient continuously, so that the procedure can be completed in a safe environment. The billing for sedation services has to be representative of the actual services that the physician delivers. When pediatric sedation services are hospital- based (the sedation providers are employed by the hospital), the activity of the hospital-employed nurses cannot be included in the professional charges: only the actual services that the physician alone performs can be utilized in billing for his/her professional service. Professional services should be billed by the entity that employs the physician. No matter whether the physician is in private practice or is employed by a large entity, the billing rules for professional services apply.