Special Alert March 2026 - Outpatient Surgical Site of Service Notice

By May 11, 2026: (1) Billing team must update prior authorization submission process to explicitly identify when any of the 43 affected CPT codes will be performed at hospital outpatient setting (place of service 22). (2) Obtain signed attestation from all providers indicating whether geographically accessible ASCs are available; encourage prospective attestation submission now to Providence. (3) Update prior authorization request templates and encounter forms to require providers to indicate planned site of service and ASC availability. (4) Train billing staff that if medical necessity criteria are not met for outpatient hospital site of service, the claim will require service to be performed at ASC instead for coverage. (5) Configure billing system to flag any prior authorization requests for the listed CPT codes performed at place of service 22 for additional medical necessity review before submission. (6) Communicate to orthopedic surgery providers that existing prior authorization requirements remain in place but now include site-of-service medical necessity review. Failure to clearly indicate site of service or provide ASC attestation may delay prior authorization review. Use Providence Care Advance Provider Portal for medical necessity questionnaires when possible for streamlined/automatic authorization.