[Ohio] Expanding Site of Care Program for musculoskeletal and surgical procedures

Before April 1, 2026: (1) Billing team must update authorization submission workflows to require precertification for all musculoskeletal and surgical procedures scheduled at outpatient hospital settings. (2) Front desk and scheduling staff must identify procedure venue (hospital outpatient vs. ASC vs. office) at time of scheduling and route to authorization team accordingly. (3) Providers should review the complete Surgical Site of Care policy (linked in bulletin) to understand which MSK and surgical CPT codes are included in the expanded program. (4) Update internal communication templates and patient notices to explain potential venue changes (e.g., procedures moving from hospital to ASC). (5) Contact Anthem via Availity Chat (https://Availity.com) to clarify which specific CPT codes trigger precertification requirements, as the policy references 'expanded MSK and surgical CPT codes' but does not list them. Failure to obtain precertification for outpatient hospital procedures may result in claim denials or payment reductions.