[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-662054-en":3,"doc-seo-662054-105":30,"detail-sidebar-cat-0-en-105":97},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},662054,3985747872983,"adawds","https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d",7,"Healthcare","PA.248.CC - Site of Service Policy - Prior Authorization","County Care’s Prior Authorization requirements define criteria for approving outpatient procedures when the requested place of service is an inpatient level of care setting. The policy evaluates whether the procedure is medically necessary in an appropriate clinical setting, including enhanced monitoring needs, supervision requirements, and risk of emergency resuscitation, inpatient admission, or intensive care. Appendix A lists specific outpatient surgical procedures that require inpatient-level authorization; Appendix B provides the ASA physical status classification for clinical risk assessment.","CLINICAL POLICY AND PROCEDURE MANUAL  \nPolicy Number: PA.248.CC  \nLast Review Date: 07/20/2022  \nEffective Date: 07/20/2022  \nPA.248.CC Site of Service Policy  \nSummary:  \nCounty Care’s Prior Authorization requirements ensure that all requested services are both medically necessary and are conducted in an optimal clinical setting. This Policy defines the criteria that County Care uses to evaluate requests for outpatient procedures to be performed in an inpatient level of care setting. The medical necessity of the procedure itself in the appropriate place where it will be provided, will be reviewed against applicable policy.  \nSurgery can be safely performed in a variety of outpatient settings, including in an oncampus or off-campus outpatient hospital facility, in an ambulatory surgical center, in a doctor’s office, and occasionally in other locations. A patient’s clinical need determines the optimal setting.  \nCounty Care encourages the use of the safest and most appropriate places of service for certain medically necessary outpatient surgical procedures. In addition to meeting existing medical necessity criteria detailed in this policy, Site of Service Prior Authorization is required when the requested place of service is an inpatient level of care setting rather than an outpatient setting , for the surgical procedures listed in Appendix A.  \nThe services found in Appendix A do not require Prior Authorization when performed inan outpatient setting.  \nClinician will refer member to case management support to assist with barriers and connect with discharge planner to collaborate on member needs.  \nRELATED DOCUMENTATION:  \n• Appendix A: Outpatient Procedures requiring Prior Authorization when requested at an inpatient level of care setting  \n• Appendix B: ASA Physical Status Classification System  \nClinical Criteria:  \nDeterminations of Medical Necessity for requests to perform a procedure at an Inpatient level of care setting will be made using the following criteria noted below.  \nServices Medically Necessary at an Inpatient level of care setting:  \nA. A surgery or procedure in an inpatient level of care setting is considered medically necessary when all the following are present:  \n1. The procedure requires that it be performed only by, or under, the general supervision of a licensed clinician; and  \n2. The individual's medical status or the procedure requires enhanced monitoring beyond what would routinely be needed for rendering such services in a free-standing ambulatory procedural setting or an outpatient setting; and  \n3. The potential changes in the individual's medical status could require emergency resuscitation care, and inpatient admission or intensive care. For example, the individual is at significant risk of sudden life-threatening changes in medical status based on clinical conditions including but not limited to:  \na. Concerns regarding fluid overload status; or  \nb. History of significant instability during a prior procedure that is  \nconsidered a risk for other future procedures; or  \nc. At risk for excessive bleeding; or  \nd. Acute mental status changes; or  \ne. Increased risk for complication due to severe comorbidity, such as that evidenced by an American Society of Anesthesiologist’s (ASA) class III physical status or greater (see Appendix B); or  \nProlonged surgery and unanticipated changes to surgery that requires inpatient stay.  \nServices Not Medically Necessary at an Inpatient level of care setting:  \nRequests for procedures that do not meet the criteria above will be considered not medically necessary at an inpatient level of care and would require redirection to anoutpatient setting.  \nLimitations:  \nAll other procedures/CPT codes not found in Appendix A are excluded from review under this policy.  \nThis policy is intended to provide guidance for in-network care facilities. All requests for procedures done in any facility outside of CountyCare’s contracted network (Out of Network) are subject to a","cbCaidu6TXHcgVyh","https://ap.wps.com/l/cbCaidu6TXHcgVyh","pdf",262109,1,9,"English","en",105,"# Policy Overview\n## Summary and Scope\n# Clinical Criteria\n## Medically Necessary at an Inpatient Level of Care\n## Not Medically Necessary at an Inpatient Level of Care\n# Limitations and Related Documentation\n## Limitations and Network Requirements\n## Appendix A\n## Appendix B","[{\"question\":\"When is an outpatient procedure considered medically necessary in an inpatient level of care setting?\",\"answer\":\"It is medically necessary only when the procedure is performed under general supervision by a licensed clinician, requires enhanced monitoring beyond typical outpatient settings, and carries risk of significant medical status changes that could require emergency resuscitation and inpatient or intensive care admission.\"},{\"question\":\"What happens when a request does not meet the inpatient medical necessity criteria?\",\"answer\":\"Requests that do not meet the stated criteria are considered not medically necessary for an inpatient level of care setting and require redirection to an outpatient setting.\"},{\"question\":\"Which procedures in Appendix A require Prior Authorization when requested at an inpatient level of care setting?\",\"answer\":\"Appendix A lists outpatient procedures that require Prior Authorization when the requested place of service is inpatient-level care rather than outpatient. Procedures listed in Appendix A do not require Prior Authorization when performed in an outpatient setting.\"}]","PA.248.CC - Site of Service Policy - Prior Authorization | PDF",1793198171,23,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":92,"head_meta":94,"extra_data":96,"updated_unix":28},"pa248cc-site-of-service-policy-prior-authorization","",{"@graph":36,"@context":91},[37,54,74],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/document/","Document",2,{"item":49,"name":12,"@type":43,"position":50},"https://docshare.wps.com/document/healthcare/",3,{"item":52,"name":13,"@type":43,"position":53},"https://docshare.wps.com/document/pa248cc-site-of-service-policy-prior-authorization/662054/",4,{"url":52,"name":13,"@type":55,"image":56,"author":61,"headline":13,"publisher":63,"fileFormat":66,"inLanguage":23,"description":14,"dateModified":67,"datePublished":68,"encodingFormat":66,"isAccessibleForFree":69,"interactionStatistic":70},"DigitalDocument",{"url":57,"@type":58,"width":59,"height":60},"https://docshare.wps.com/thumbnails/pa248cc-site-of-service-policy-prior-authorization/662054.png","ImageObject",300,407,{"name":9,"@type":62},"Person",{"url":41,"name":64,"@type":65},"DocShare","Organization","application/pdf","2026-10-29","2026-10-28",true,{"@type":71,"interactionType":72,"userInteractionCount":20},"InteractionCounter",{"@type":73},"ViewAction",{"@type":75,"mainEntity":76},"FAQPage",[77,83,87],{"name":78,"@type":79,"acceptedAnswer":80},"When is an outpatient procedure considered medically necessary in an inpatient level of care setting?","Question",{"text":81,"@type":82},"It is medically necessary only when the procedure is performed under general supervision by a licensed clinician, requires enhanced monitoring beyond typical outpatient settings, and carries risk of significant medical status changes that could require emergency resuscitation and inpatient or intensive care admission.","Answer",{"name":84,"@type":79,"acceptedAnswer":85},"What happens when a request does not meet the inpatient medical necessity criteria?",{"text":86,"@type":82},"Requests that do not meet the stated criteria are considered not medically necessary for an inpatient level of care setting and require redirection to an outpatient setting.",{"name":88,"@type":79,"acceptedAnswer":89},"Which procedures in Appendix A require Prior Authorization when requested at an inpatient level of care setting?",{"text":90,"@type":82},"Appendix A lists outpatient procedures that require Prior Authorization when the requested place of service is inpatient-level care rather than outpatient. 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