At Blue Cross, part of our nonprofit mission is to help our members find the highest quality care available, while keeping costs down. The Site of Service program is designed to make members’ dollars go further for them. For some patients with some procedures, it's not medically necessary to be in a higher cost hospital setting. For these situations, ASCs are often a lower cost alternative and have shown potential for lower risk of infection with equal or better outcomes.
Procedures included
Over time, we’ll add more procedures to this program. This initiative is driven by medical policy, aimed at ensuring members receive quality services at a lower cost.
When the following procedures are performed for our Commercial (Fully-Insured and Self-Insured) and Medicaid* plan members, they are subject to this policy and must be performed in a non-hospital outpatient setting, such as an ambulatory surgical center (ASC) or physician’s office, to be eligible for reimbursement, unless certain medical or geographic criteria are met for the procedure to be performed in a hospital outpatient facility.
*Medicaid plans included in this policy are Minnesota Health Care Programs (MHCP), including Blue Advantage Families and Children (formerly Prepaid Medical Assistance Program), and MinnesotaCare (MNCare).
Upper and lower gastrointestinal endoscopy (GI) procedures
Codes: 43235, 43239, 43249, 45378, 45380, 45384, 45385, G0105, G0121
Ear, nose and throat (ENT) procedures
Codes: 21320, 30140, 30520, 69436, 69631
Hernia procedures
Codes: 49505, 49650, 49651
Gynecologic procedures
Codes: 57522, 58353, 58558, 58563, 58565
Orthopedic arthroscopy and foot procedures
Codes: 29891-29899, 29830, 29834-29838, 29860-29863, 29914-29916, 29870, 29873-29875, 29876, 29877, 29879-29889, 29805-29807, 29819-29828, 29840, 29844-29848, 28289, 28291, 28292, 28296-28299, 28285
Get details
- Provider bulletin: Site of service for selected outpatient procedures: XI-03 medical policy update (PDF) (posted Aug. 3, 2020)
- See medical policy
Exemption for some hospital outpatient facilities
Hospital outpatient facilities with no in-network ASCs that provide these services within 25 miles of their location are exempt from this program.
Facilities interested in continuing to provide these services in the outpatient hospital setting may contact their Blue Cross contract manager to discuss adjusting reimbursement rates to better align with the ASC setting.
More information
See ongoing communications for regular updates.
See latest provider bulletins and quickpoints