Site of Service Review Required for Select Procedures January 1, 2027

Starting January 1, 2027, select procedures that do not require a medical necessity review will require a site of service review. This review determines whether a procedure can be safely performed in a lower-cost ambulatory surgical center (ASC). Ambulatory surgical centers provide high-quality care and can help lower costs for patients.

What’s Changing

The following procedures require site of service review:

• Colonoscopies
• Hemorrhoid procedures
• Tonsillectomies
• Bunion surgeries

What You’ll Need to Do

Get prior authorization when affected procedures are performed in an outpatient hospital or inpatient setting. Prior authorization is not required when these procedures are performed in an ASC.

Stay Tuned

Check our medical policies for updates. We’ll share more information about the new requirements before January 1, 2027.