For some kinds of care, you can have the same service done at a hospital or a non-hospital outpatient surgery center. These are sometimes called ambulatory surgery centers (ASCs). The safety and effectiveness of the care is the same, but the cost can be much less at an ASC. The site of service program supports a shift to ASCs.
Many surgeries now performed at ASCs
Ambulatory (outpatient) surgery centers (ASCs) are modern health care facilities that offer same-day, outpatient surgery for both diagnosis and prevention.
Today, more than half of all surgeries performed in the country are done on an outpatient basis. Advances in techniques, anesthesia and pain management let patients safely and comfortably recover from surgery in their own homes.1
Members can save money
As an example of the savings member may see as a result of this policy, Blue Cross studied claims data for two common gastrointestinal and endoscopy services, including colonoscopies. The average price is nearly $1,300 more at a hospital than at an ASC. With the site of service program, a member with a $2,000 deductible and 20 percent coinsurance saves an average of $260 in out-of-pocket costs for these services.
Program based on evidence
The program isn't a change in your benefits. It's a change in how we pay health care providers for care. It's based on a medical policy originally developed in March 2019. Medical policies are created and updated regularly based on evidence-based best practices. The site of service medical policy is based on evidence showing that, for people who are otherwise healthy, an ASC is a convenient alternative to an outpatient hospital setting. It offers the same quality and lower costs – for everyone. So we're asking doctors to refer patients to ASCs when it makes sense.
Surgeries included in the program
Currently, some types of gastrointestinal, ear/nose/throat, hernia, gynecology and arthroscopy procedures are included. Here are the procedure codes (a way to classify medical procedures). You can see descriptions for each procedure code in the site of service medical policy.
- Upper and lower gastrointestinal endoscopy procedures (including colonoscopies)
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
Talk to your doctor or call the number on the back of your Blue Cross card for help finding the appropriate place for your care.
Answers to common questions
How do I know if this applies to me?
If you’re 18 or older, have Blue Cross health insurance through your employer or through Medicaid* and are planning to receive one of the services included in the list above, this program may apply to you.
*Minnesota Health Care Programs (MHCP), including Blue Advantage Families and Children (formerly Prepaid Medical Assistance Program), and MinnesotaCare (MNCare).
If I have one of these services done at a hospital when it should've happened at a lower-cost setting, will I have to pay the full price of the procedure myself?
No, you do not have to pay if a procedure in the site of service medical policy is not performed at the appropriate site of service.
Exceptions: Sometimes hospitals are covered
While, in general, this program is designed to help members get care at ASCs, there are some cases where an in-network hospital is exempt from the policy and is covered:
- Hospitals that have agreed to provide these services at a lower cost for our members
- Hospitals where there is no ASC that provides these services within 25 miles of the hospital
- Hospitals (or other appropriate non-hospital places) where there isn’t an in-network ASC that provides the services within 25 miles of a member’s home
Working to balance cost and quality supports health care sustainability. Learn more about health care sustainability.
To learn more about the benefits and value of having certain procedures at an ASC, please read this blog post: Where are you planning to have your surgery? Here’s why it matters.
