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.
- END -