CommercialCoverageHigh impact
[New York] Expanding Site of Care Program for musculoskeletal and surgical procedures
Anthem BCBS·NY · Orthopedics, General Surgery, Neurosurgery +9 more·Provider Bulletin
We identified it
May 3, 2026
Summary
Anthem (New York) is expanding their Site of Care Program to include musculoskeletal and surgical procedures, which will likely require certain procedures to be performed in lower-cost settings like ASCs or outpatient facilities instead of hospital inpatient settings.
Action Required
Immediately: Access the full policy details at the provided URL to determine specific affected procedures and requirements. Review current authorization workflows for musculoskeletal and surgical procedures. Update prior authorization processes to verify appropriate site of care requirements before scheduling procedures. Monitor for claim denials related to site of care restrictions.