All PlansCoverageMedium impact
PAP216 - Surgical Suites - Added additional clarification
Blue Cross of Idaho·ID · General Surgery, Orthopedics, Plastic Surgery +5 more·Medical Policy
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho clarified that surgical suites and treatment rooms are not covered when surgical services are performed in office settings, whether on or off hospital campus. Office-based procedures will be evaluated for proper site of service coding to ensure accurate benefit application.
Action Required
Immediately: Billing team must verify all office-based surgical procedures are coded with appropriate office site of service codes (not facility codes). Review recent claims for surgical procedures performed in office settings to ensure proper site of service coding. Do not submit separate charges for surgical suite or treatment room fees when procedures are performed in office locations.