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 requiring elective procedures to be performed at the hospital outpatient level of care instead of inpatient level when medically appropriate. This policy will affect billing and prior authorization requirements for elective procedures that were previously approved for inpatient settings.
Action Required
Before June 1, 2026: Billing team must review all elective procedure scheduling and billing processes to ensure procedures are coded for outpatient level of care when appropriate. Update prior authorization requests to reflect outpatient settings for elective procedures. Providers must modify care plans and patient scheduling to comply with outpatient requirements. Failure to follow new level of care guidelines may result in claim denials.