Office-Based Procedures – Site of Service – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers elective procedures in an ambulatory surgical center (ASC) only if one of specified criteria is met — e.g., allergy to local anesthetic, bleeding disorder, developmental/cognitive limitations, failed office attempts, unsafe comorbidities, or inability to access an appropriately equipped or in‑network office — otherwise the ASC site is not covered. Prior authorization is required for listed codes not done in an office, medical records documenting the applicable criterion and lack of office access must be provided, and final coverage is determined by the member’s benefit plan and does not guarantee payment.

"UnitedHealthcare members may choose to receive surgical procedures in an office setting or other locations. We are conducting site of service medical necessity reviews, however, to determine whethe..."

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