Providers
Chapter 11
Section 6.1
Ambulatory Surgery
Issue Date: August 31, 1987
Revision:
1.0 DESCRIPTION
Surgery provided to the patient on an outpatient,
walk-in, same day basis in an appropriately equipped and staffed
health facility with surgery usually conducted under general anesthesia
with no overnight stay in the hospital required. Also called same
day surgery.
2.0 POLICY
2.1 Benefits
are payable for medically necessary surgical procedures when ordered
and provided or supervised by a physician, and performed in authorized
freestanding ambulatory surgical facilities or hospital outpatient
setting (e.g., a clinic, Ambulatory Surgery Center (ASC), or Emergency
Room (ER)).
2.2 Institutional charges submitted by unauthorized
ambulatory surgery centers cannot be covered.
2.3 Professional
services provided by authorized individual professional providers
in an unauthorized ambulatory surgical center will be covered on
an outpatient basis if the surgical procedure is a covered benefit.
2.4 Professional
services provided by employees of unauthorized centers cannot be
covered.
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