As of Aug. 1, EmblemHealth will require preauthorization for certain hospital outpatient surgeries (places of service 19 and 22) for all members under age 75. Only surgeries that are clinically appropriate in a hospital setting will be approved. See Notable Changes for the specific services and codes that will require preauthorization along with other changes to the list including the removal of 303 services.
The same surgeries scheduled in an ambulatory surgery center (ASC) or physician office will not require preauthorization. Surgeons are encouraged to obtain privileges at an ASC so their patient’s insurance can cover procedures that will not be approved in a hospital outpatient setting.
We are providing advance notice of this change to allow surgeons a three-month grace period to partner with an ASC. To find a participating ASC that is accepting new doctors for the surgeries you perform, see this list. For questions, send a message to our Provider Customer Service team using the provider portal’s Message Center or Live Agent Chat.
