CurrentUnitedHealthcarePolicy MP.12.20

Office-Based Procedures - Site of Service

Defines medical necessity criteria for performing elective surgical procedures in an ambulatory surgical center (ASC) versus an office setting, lists applicable CPT codes requiring prior authorization when not performed in an office, and summarizes documentation and safety guidance.

Policy Summary

PayerUnitedHealthcare

PolicyOffice-Based Procedures - Site of Service

Policy CodePolicy MP.12.20

Change TypeRoutine review; no change to coverage guidelines

Effective DateJuly 1, 2025

Next Review Date

Key ActionPrior authorization is required for procedures listed in the Applicable Codes section if not performed in an office setting.

POLICY UPDATE CHANGES

07/01/2025 routine review; no change to coverage guidelines

1Policy pages

MultipleApplicable CPT codes listed

0Material coverage changes in last revision

Coverage Summary

Scope: Defines medical necessity criteria for performing elective surgical procedures in an ambulatory surgical center (ASC) versus an office setting, lists applicable CPT codes requiring prior authorization when not performed in an office, and summarizes documentation and safety guidance. Policy Number: MP.12.20. Effective Date/Last Review: July 1, 2025.