Special Alert March 2026 - Outpatient Surgical Site of Service Notice

By May 11, 2026: (1) Billing and authorization team must update prior authorization submission processes to include site of service (place of service 22) medical necessity review for all 43 affected CPT codes. (2) Update billing system and PA submission templates to require providers to clearly indicate if procedures will be performed in hospital outpatient setting. (3) If facility does not have geographically accessible ASC or lacks ASC privileges, obtain and file signed attestation with Providence Health Plan NOW (prospective filing encouraged to prevent future auth delays). (4) Educate providers to note on PA requests if no ASC is available to prevent authorization delays. (5) Encourage providers to use Care Advance Provider Portal and complete medical necessity questionnaires for these procedures to streamline process and enable automatic authorizations. (6) Train front-desk and authorization staff that procedures not meeting outpatient hospital medical necessity criteria must be rerouted to ASC or claims will be denied. Applies to Providence commercial fully insured groups only—Medicare and OHP members are excluded.