covered surgical procedures under ASC billing

Covered Surgical Procedures

Covered surgical procedures are procedures that meet the following criteria:

• Surgical procedures commonly performed on an inpatient basis in hospitals but may be safely performed in an ambulatory surgical center setting

• Surgical procedures limited to those requiring a dedicated operating room and generally requiring a post-operative recovery room or short-term (not overnight) convalescent room

• Surgical procedures not otherwise excluded under 42 C.F.R. § 416.65 or other regulatory requirement

• Procedure codes within the range of 10000-69XXX

Medicaid maintains a listing of the covered surgical procedures in Appendix I, ASC Procedures List. This list is reviewed and updated on a quarterly basis. Providers should refer to the fee schedule before scheduling outpatient surgeries since some procedures are restricted to recipients under age 20 and others may require prior authorization.