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The Managed Care Support (MCS) Manuals (T-3) for contracts prior to 07/21/2016 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each T-17 manuals' web page.
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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