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.