Medicare AdvantageCoverageHigh impact
MA12.005, Site of Care for Elective Procedures [Hospital Outpatient Setting to Ambulatory Surgical Center (ASC)]
Independence Blue Cross·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 19, 2026
Summary
New Medicare Advantage policy MA12.005 requires elective procedures to be performed in Ambulatory Surgical Centers (ASCs) instead of hospital outpatient settings when appropriate. This policy aims to redirect certain elective procedures from more expensive hospital outpatient departments to lower-cost ASC facilities.
Action Required
By June 1, 2026: Billing team must review all elective procedures scheduled for Medicare Advantage patients and verify appropriate site of service. Update scheduling protocols to direct eligible elective procedures to ASCs instead of hospital outpatient settings. Providers must document medical necessity if hospital outpatient setting is required over ASC. Update authorization workflows to reflect new site of care requirements.