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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