[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-662060-105":59,"doc-detail-662060-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","outpatient-surgical-procedures-site-of-service","Outpatient Surgical Procedures - Site of Service","","Outpatient Surgical Procedures - Site of Service outlines UnitedHealthcare’s medical policy for deciding when outpatient surgical care in a hospital outpatient department is medically necessary. Site-of-service determinations guide coverage under commercial and individual exchange benefit plans, using member-eligibility criteria and medically necessary clinical thresholds. The policy specifies circumstances where planned hospital outpatient procedures are required, including anticipated overnight recovery, transfusion needs, comorbid conditions, and inability to access an ASC with appropriate equipment or privileges. Documentation requirements and applicable codes support review decisions.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/outpatient-surgical-procedures-site-of-service/662060/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/outpatient-surgical-procedures-site-of-service/662060.png","ImageObject",300,407,{"name":92,"@type":93},"vwvw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-10-28",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"This policy covers which plans for outpatient surgical procedures at a hospital site?","Question",{"text":112,"@type":113},"It applies to UnitedHealthcare Commercial benefit plans and UnitedHealthcare Individual Exchange benefit plans, with specified exclusions by benefit type and state.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"When is a planned surgical procedure in a hospital outpatient department considered medically necessary?",{"text":117,"@type":113},"When the individual meets defined clinical criteria (such as advanced organ disease, significant comorbid conditions, or prolonged surgery) and when site-of-service requirements justify hospital outpatient care.",{"name":119,"@type":110,"acceptedAnswer":120},"What if an ambulatory surgical center (ASC) is not accessible for the procedure?",{"text":121,"@type":113},"The policy allows medical necessity when there are ASC limitations related to the person’s health conditions or when no geographically accessible ASC has the necessary equipment or when the physician lacks privileges at an ASC.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},662060,1793198190,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":52},3985747874149,"https://ap-avatar.wpscdn.com/avatar/3a001161165b4dc3d9e?x-image-process=image/resize,m_fixed,w_180,h_180&k=1790129441039064114","UnitedHealthcare® Commercial and Individual Exchange  \nMedical Policy  \nOutpatient Surgical Procedures –Site of Service  \nPolicy Number: MP.11.27  \nEffective Date: August 1, 2026 􀃂 Instructions for Use  \nTable of Contents Page  \nApplication ............................................................................. 1  \nCoverage Rationale .............................................................. 1  \nMedical Records Documentation Used for Reviews ............. 2  \nDefinitions.............................................................................. 2  \nApplicable Codes .................................................................. 3  \nReferences ............................................................................ 3  \nPolicy History/Revision Information ...................................... 3  \nInstructions for Use ............................................................... 4  \n\n| Related Commercial/Individual Exchange Policies |\n| --- |\n| •  Cosmetic and Reconstructive Procedures\u003Cbr>•  Glaucoma Surgical Treatments\u003Cbr>•  Hysterectomy\u003Cbr>•  Light and Laser Therapy\u003Cbr>•  Manipulation Under Anesthesia\u003Cbr>•  Obstructive and Central Sleep Apnea Treatment\u003Cbr>•  Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache)\u003Cbr>•  Oral Surgery: Non-Pathologic Excisional Procedures\u003Cbr>•  Percutaneous Vertebroplasty and Kyphoplasty\u003Cbr>•  Preventive Care Services\u003Cbr>•  Screening Colonoscopy Procedures – Site of Service\u003Cbr>•  Sodium Hyaluronate\u003Cbr>•  Surgery of the Hip\u003Cbr>•  Surgery of the Knee\u003Cbr>•  Surgery of the Wrist or Thumb |\n\n\n| Community Plan Policy |\n| --- |\n| •  Outpatient Surgical Procedures – Site of Service |\n\n\n| Medicare Advantage Policy |\n| --- |\n| •  Hospital, Emergency, and Ambulance Services |\n\nApplication  \nUnitedHealthcare Commercial  \nThis Medical Policy applies to UnitedHealthcare Commercial benefit plans, except UnitedHealthcare West benefit plans.  \nUnitedHealthcare Individual Exchange  \nThis Medical Policy applies to Individual Exchange benefit plans in all states , except for Illinois, Massachusetts, Nevada, Texas, and Wisconsin.  \nCoverage Rationale  \nUnitedHealthcare members may choose to receive surgical procedures in an ambulatory surgical center (ASC) or at other locations. However, we are conducting site-of-service medical necessity reviews to determine whether the outpatient hospital department is medically necessary, in accordance with the terms of the member’s benefit plan. If the outpatient hospital department is not considered medically necessary, this location will not be covered under the member’s plan.  \nCertain planned surgical procedures performed in a hospital outpatient department are considered medically necessary for an individual who meets any of the following criteria:  \n Advanced liver disease (Model for End-Stage Liver Disease score > 8)  \n Advance surgical planning determines that an individual requires overnight recovery and care following a surgical procedure  \n Anticipated need for transfusion  \n Bleeding disorder requiring replacement factor or blood products or special infusion products to correct a coagulation defect  \n Cardiac arrhythmia (symptomatic arrhythmia despite medication)  \n Chronic obstructive pulmonary disease [forced expiratory volume in 1 second (FEV1) \u003C 50%]  \n Coronary artery disease/peripheral vascular disease [ongoing cardiac ischemia requiring medical management or recently placed (within 1 year) drug-eluting stent]  \n Developmental stage or cognitive status warranting use of a hospital outpatient department  \n End-stage renal disease [(hyperkalemia above reference range) receiving peritoneal dialysis or hemodialysis]  \n History of cerebrovascular accident or transient ischemic attack [recent event (\u003C 3 months)]  \n History of myocardial infarction [recent event (\u003C 3 months)]  \n Individuals with drug-eluting stents placed within 1 year or bare metal stents or plain angioplasty within 90 days unless acetylsalicylic acid","cbCaigR6vbOhGDMa","https://ap.wps.com/l/cbCaigR6vbOhGDMa","pdf",373497,"English","# Application\n## Coverage Rationale\n## Medical Records Documentation Used for Reviews\n## Definitions\n## Applicable Codes\n## References\n## Policy History/Revision Information\n## Instructions for Use","[{\"question\":\"This policy covers which plans for outpatient surgical procedures at a hospital site?\",\"answer\":\"It applies to UnitedHealthcare Commercial benefit plans and UnitedHealthcare Individual Exchange benefit plans, with specified exclusions by benefit type and state.\"},{\"question\":\"When is a planned surgical procedure in a hospital outpatient department considered medically necessary?\",\"answer\":\"When the individual meets defined clinical criteria (such as advanced organ disease, significant comorbid conditions, or prolonged surgery) and when site-of-service requirements justify hospital outpatient care.\"},{\"question\":\"What if an ambulatory surgical center (ASC) is not accessible for the procedure?\",\"answer\":\"The policy allows medical necessity when there are ASC limitations related to the person’s health conditions or when no geographically accessible ASC has the necessary equipment or when the physician lacks privileges at an ASC.\"}]","Outpatient Surgical Procedures - Site of Service | PDF"]