Site of Service review for ambulatory surgical center (ASC) for select elective surgical or diagnostic procedures in adults
Defines medical necessity criteria for the appropriate site of service (ASC, on-campus/out‑campus outpatient hospital, inpatient hospital) for selected elective surgical and diagnostic procedures and lists applicable CPT/HCPCS codes. Prior authorization/site-of-service review is required for listed procedures; criteria identify when ASC is preferred or when hospital setting is medically necessary.
Added shoulder arthroscopy CPT codes 23700, 29805-29807, 29819-29828 as medically necessary in ASC when criteria met (effective 02/06/26).
Added cardiac surgery section to include implantable loop recorder surgery and codes 33285 and E0616 (effective 04/08/26).
Title changed to include diagnostic procedures and added Upper GI Endoscopy (2.01.533) to list (effective March-April-July 2026 adjustments to effective date).
Added header that site of service review does not apply to Indian Health Services (IHS) facilities (06/01/26).
Updated ASA Physical Status Classification table to include adult examples (12/01/25).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.