John Seitz, MDAnesthesiology
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Monitored Anesthesia Care (MAC): What It Is and How It Differs from Moderate Sedation

How MAC differs from moderate sedation in staffing, monitoring, documentation and billing, and what a practice should specify when arranging it.

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Monitored anesthesia care, usually written as MAC, is an anesthesia service provided for a procedure in which sedation and analgesia are titrated to the patient and to the surgical requirements. It is frequently combined with local anesthesia, and the depth of anesthesia produced may range from minimal sedation to general anesthesia.

MAC is not the same as moderate sedation

The American Society of Anesthesiologists distinguishes the two in a dedicated statement: moderate sedation (conscious sedation) is a drug-induced level of consciousness at which the patient responds purposefully to verbal commands, with the practitioner performing the procedure typically also supervising the sedation. MAC is described as a specific anesthesia service performed by a qualified anesthesia provider.1 The distinction carries consequences for staffing, monitoring, documentation and billing.

What the monitoring standards require

The ASA Standards for Basic Anesthetic Monitoring apply to monitored anesthesia care. They require qualified anesthesia personnel in the room and continual evaluation of oxygenation, ventilation and circulation, with temperature monitored when a clinically significant change is intended, anticipated or suspected.2

Depth can change during a case

Because sedation exists on a continuum, a patient may reach a deeper level than intended. The ASA states that practitioners should be able to rescue patients from a level deeper than the one planned, and that continuing a procedure at an unintended level of sedation is not appropriate.3 A MAC plan therefore includes the airway equipment, drugs and personnel needed to convert to a general anesthetic.

What a practice should specify when arranging MAC

Coverage arrangements should name the anesthesia provider and their qualifications, the monitoring to be used, the plan for deeper-than-intended sedation, the emergency and transfer arrangements, and who is responsible for recovery and the discharge decision. See our articles on office-based anesthesia safety and the levels of sedation.

Sources

  1. American Society of Anesthesiologists. Statement on Distinguishing Monitored Anesthesia Care ("MAC") from Moderate Sedation/Analgesia (Conscious Sedation). Developed by the Committee on Economics. Original approval October 18, 2023.
  2. American Society of Anesthesiologists. Standards for Basic Anesthetic Monitoring. Original approval October 21, 1986; last amended October 15, 2025.
  3. American Society of Anesthesiologists. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Original approval October 13, 1999; last amended October 23, 2024.
Portrait of Dr. John Seitz, MD

Dr. John Seitz, MD

Board-certified anesthesiologist

This article is for general educational purposes and is not a substitute for personalized medical advice. Always consult your physician for guidance specific to your health.

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