Providers
Chapter 11
Section 6.2
Freestanding Ambulatory
Surgery Center (ASC)
Issue Date: June 20, 1988
Revision:
2.0 POLICY
2.1 Each contractor
is the certifying authority for applications for status as an authorized institutional
provider for freestanding ASCs located within their geographical
jurisdiction.
2.2 Freestanding ASCs are covered under the following
circumstances:
2.2.1 The treatment is prescribed and supervised
by a physician;
2.2.2 The type and level of care
and services rendered by the center are covered services;
2.2.3 The center
meets all licensing or other certification requirements of the jurisdiction
in which the facility is located; and
2.2.4 The center is accredited by
the Joint Commission or the Accreditation Association for Ambulatory
Health Care, Inc. (AAAHC), or other standards as authorized by the
Director, Defense Health Agency (DHA). Status as an accredited Medicare
Freestanding ASC is accepted in lieu of accreditation by the Joint
Commission or the AAAHC. The contractors may contact the Medical
Benefits and Reimbursement Section (MB&RS) Division to determine
if other accreditation organizations can be recognized by TRICARE.
2.2.5 A childbirth
procedure provided by an authorized freestanding ASC shall not be
covered unless the ASC is also an authorized birthing center institutional
provider as established by the birthing center provider certification
requirements.
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