Gastrointestinal endoscopy is one of the safest and most commonly performed adult procedures. The record of safety extends to the sedation or anesthesia for both upper and lower GI endoscopy.  Because of both the safety and the frequency of the procedure, anesthesia for GI endoscopy has been under scrutiny by health plans for a decade or more.  Lately, the number of claims denied for lack of “medical necessity” for endoscopic anesthesia services have once again been growing.  Without taking any position on the merits of anesthesia vs. moderate sedation in connection with endoscopies and especially colonoscopies, we would like to remind our audience of the principles followed by payers in evaluating the medical necessity of anesthesia for these procedures. The differences between anesthesia and moderate sedation Moderate sedation (aka “conscious sedation”) is a “drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile...