Outpatient Surgical Procedures. A. Benefits are available for surgical procedures performed by Contracting Providers on an outpatient basis, including.
B. Benefits are available for services in a hospital outpatient department or in an ambulatory surgical facility, in connection with a covered surgical procedure, including:
1. Use of operating room and recovery room.
2. Use of special procedure rooms.
3. Diagnostic procedures, laboratory tests, and radiology services.
4. Drugs, medications, solutions, biological preparations, and services associated with the administration of the same.
5. Medical and surgical supplies.
6. Blood, blood plasma and blood products, and related donor processing fees that are not replaced by or on behalf of the Member. Administration of infusions is covered.
Outpatient Surgical Procedures. SAMPLE
A. Benefits are available for surgical procedures performed by a health care provider on an outpatient basis including, but not limited to, colonoscopy, sigmoidoscopy, and endoscopy.
B. Benefits are available for services in a hospital outpatient department or in an ambulatory surgical facility, in connection with a covered surgical procedure, including:
1. Use of operating room and recovery room.
2. Use of special procedure rooms.
3. Diagnostic procedures, laboratory tests, and radiology services.
4. Drugs, medications, solutions, biological preparations, and services associated with the administration of the same.
5. Medical and surgical supplies.
6. Blood, blood plasma and blood products, and related donor processing fees that are not replaced by or on behalf of the Member. Administration of infusions is covered.
Outpatient Surgical Procedures. A. Benefits are available for surgical procedures performed by Contracting Providers on an outpatient basis, including, but not limited to, colonoscopy, sigmoidoscopy, and endoscopy. Services provided to the Member as an outpatient in a hospital must receive prior authorization from CareFirst BlueChoice.
B. Benefits are available for services in a hospital outpatient department or in an ambulatory surgical facility, in connection with a covered surgical procedure, including:
1. Use of operating room and recovery room.
2. Use of special procedure rooms.
3. Diagnostic procedures, laboratory tests, and radiology services.
4. Drugs, medications, solutions, biological preparations, and services associated with the administration of the same.
5. Medical and surgical supplies.
6. Blood, blood plasma and blood products, and related donor processing fees that are not replaced by or on behalf of the Member. Administration of infusions is covered.
Outpatient Surgical Procedures. Benefits are available for surgical procedures performed by Health Care Practitioners on an outpatient basis.
Outpatient Surgical Procedures a. For procedures commonly performed in physicians' offices, as determined by BCBSM, the fees are based on a percentage of the technical component of the BCBSM physician fee for each procedure;
b. For procedures that are not commonly performed in physicians' offices, as determined by BCBSM, the fees are aligned with the hospital fees for the same procedure;
c. In rare instances when procedures cannot be priced using the above methods, the payment is the Provider’s charge multiplied by a percentage determined by BCBSM.
