Medicare AdvantageCoverageHigh impact
MA12.012, Level of Care for Elective Procedures (Hospital Inpatient to Hospital Outpatient Level of Care)
Independence Blue Cross·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has implemented a new policy MA12.012 that changes the level of care requirements for elective procedures from hospital inpatient to hospital outpatient settings. This policy establishes new guidelines for determining appropriate care settings for elective procedures under Medicare Advantage plans.
Action Required
Before June 1, 2026: Billing team must review all elective procedure scheduling protocols to ensure compliance with new outpatient level of care requirements. Update prior authorization workflows to reflect inpatient to outpatient care setting changes. Coordinate with scheduling staff to verify elective procedures are being scheduled at appropriate outpatient facilities when required by MA12.012 policy.