Benefit: Ambulatory Surgery

Definition: Ambulatory Surgery is a procedure that is more intensive than one done in the average doctor's office but not so intensive as to require a hospital stay. It covers surgical procedures that have been approved by the federal Centers for Medicare and Medicaid Services (CMS), that are provided in a licensed, Medicare-approved, Medicaid-participating facility that is not part of a hospital.

Limits:  Surgical procedures are limited to services that:

• Are normally not emergency or life threatening in nature;
• Do not exceed a total of 90 minutes operating time;
• Do not exceed a total of four hours recovery or convalescent time;
• Do not require major invasion of body cavities or directly involve major blood vessels;
• Do not usually result in heavy loss of blood; and
• Require a dedicated operating room.

Exceptions: None

Co-pays: None

Reform items that can vary: None