[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR416.65]



[Page 816-817]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 416_AMBULATORY SURGICAL SERVICES--Table of Contents

 

                       Subpart D_Scope of Benefits

 

Sec. 416.65  Covered surgical procedures.



    Covered surgical procedures are those procedures that meet the 

standards described in paragraphs (a) and (b) of this section and are 

included in the list published in accordance with paragraph (c) of this 

section.

    (a) General standards. Covered surgical procedures are those 

surgical and other medical procedures that--

    (1) Are commonly performed on an inpatient basis in hospitals, but 

may be safely performed in an ASC;



[[Page 817]]



    (2) Are not of a type that are commonly performed, or that may be 

safely performed, in physicians' offices;

    (3) Are limited to those requiring a dedicated operating room (or 

suite), and generally requiring a post-operative recovery room or short-

term (not overnight) convalescent room; and

    (4) Are not otherwise excluded under Sec. 405.310 of this chapter.

    (b) Specific standards. (1) Covered surgical procedures are limited 

to those that do not generally exceed--

    (i) A total of 90 minutes operating time; and

    (ii) A total of 4 hours recovery or convalescent time.

    (2) If the covered surgical procedures require anesthesia, the 

anesthesia must be--

    (i) Local or regional anesthesia; or

    (ii) General anesthesia of 90 minutes or less duration.

    (3) Covered surgical procedures may not be of a type that--

    (i) Generally result in extensive blood loss;

    (ii) Require major or prolonged invasion of body cavities;

    (iii) Directly involve major blood vessels; or

    (iv) Are generally emergency or life-threatening in nature.

    (c) Publication of covered procedures. CMS will publish in the 

Federal Register a list of covered surgical procedures and revisions as 

appropriate.