Aetna dental fee schedule 2023

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans contain exclusions and limitations. Health care providers, learn more about health insurance exchanges and get answers to ...

ZIP Code *. Find an Aetna Dentist in Your Area. Aetna Dentists Near Me. Aetna has one of the nation's largest dental networks, with more than 200,000 participating dental practices, making it easy to find a great dentist or specialist near you. Find a dentist by entering your zip code.Call us. Talk to a licensed agent at. 1-855-335-1407 (TTY: 711) Monday to Friday, 8 AM to 8 PM. Medicare FAQs. Get answers to common Medicare questions. With most Aetna Medicare Advantage HMO plans, you typically choose an in-network primary care physician who works with you to help you get the right care at the right time.From the warm greeting you get on arrival to leaving the office everyone gives you outstanding service. - Marsha G. THE BEST Dentist, Hygienist and Staff - Every …Professional Services, Lab, X-Ray, Radiology and ASC. Rehabilitation Services Reimbursement Fee Schedule. Specialized Behavioral Health Fee Schedule. Take Charge Plus Fee Schedule. TPN Fee Schedule. Vision (Eye-wear) Fee Schedule. Obsolete Fee Schedules. The Louisiana Department of Health protects and promotes health and ensures access to ...Learn more about the network that over 67,000 dentists choose.Number: 041 Revised Subject: Scaling and Root Planing Reviewed: May 3, 2023 Important note This Clinical Policy Bulletin expresses Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome ...Health plans are offered or underwritten or administered by Aetna Health Inc. (Texas) (Aetna). Aetna is part of the CVS Health ® family of companies. Health benefits and health insurance plans contain exclusions and limitations. Texas residents, find important benefits details for all Aetna CVS Health ACA individual plans available in your state.The calendar year (CY) 2023 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation. Background on the Physician Fee Schedule. Since 1992, Medicare payment has been made under the PFS for ...

The calendar year (CY) 2023 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation. Background on the Physician Fee Schedule. Since 1992, Medicare payment has been made under the PFS …The fee schedules and rates are provided as a courtesy to providers. Providers are to charge their reasonable and customary charge regardless of the anticipated reimbursement from the department. These are large and complex documents. Great care has been taken to make sure that the prepared documents and the claims payment system are the same.You should contact CPT Intellectual Property Services, American Medical Association, 515 N. State Street, Chicago, Illinois 60610 or at telephone number 312-464-5022 or at facsimile number 312-464-5131, should you wish to make additional uses of CPT. Legal notices. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans contain exclusions and limitations. See all legal notices. Oral health is essential to your overall well-being. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, is the discount medical plan organization. For more information, call 1-877-698-4825 or visit www.vitalsavings.com. Oklahoma form numbers for discount programs are: GR-96402-02 …

Dental Fee Schedule. Excel Format. PDF Format. 2024 Adults Over 21 Emergent Schedule Effective 4/1/24 - 3/31/25. 2024 Children 21 and Under Dental Schedule Effective 4/1/24 - 3/31/25. 2024 Dental Fee Schedule. 2024 Dent al Fee Schedule Effective 1/1/24 - 3/31/24. 2023 Dental Fee Schedule .June 2023. Find updates on important changes to plans and procedures, behavioral health topics, drug lists, Medicare information and state-specific details. ... No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. ... Aetna Dental Clinical Policy Bulletins (DCPBs) are ...On January 1, 2023, we expanded further into new Texas markets. ... No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. ... Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating ...The calendar year (CY) 2023 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation. Background on the Physician Fee Schedule. Since 1992, Medicare payment has been made under the PFS for ...Welcome to the LIBERTY Dental Plan Resource Library. To download a form or user guide, please select your state and then choose from the list of available documents. ... Last Date of Update 12/18/2023. Providers Providers; Disclosure of Ownership & Control Interest Form Requirements; Contract With Us; Join Our Network; Provider Portal ...CDT 2023 Dental Procedure Codes. ... Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. ... No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical ...

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CDT 2023 Dental Procedure Codes. ... Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. ... No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical ...Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agents/brokers.Summary of Benefits_2022627.pdf. MTA NEW YORK CITY TRANSIT Aetna MedicareSM Plan (PPO) MTA NYCT Option 1 Plan. Benefits and Premiums are effective January 1, 2023 through December 31, 2023. SUMMARY OF BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY. Primary Care Physician (PCP): You have the option to choose a PCP.Aetna provides free aids/services to people with disabilities and to people who need language assistance. If you need a qualified interpreter, written information in other formats, translation or other services, call 877-238-6200. 1-800-648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705),Medical supplies and durable medical equipment are reimbursed at cost times 1.5 plus $4.00 for handling fee charges. Charges greater than $50.00 must be accompanied by a copy of the wholesale vendor invoice (s) showing the actual cost of the item. Certain procedures include supplies; therefore, CPT code 99070 would not be reported.

Submit for a pretreatment estimate. You should submit a request for a pre-treatment estimate for procedures and services your dentist believes will exceed $300 (procedures such as crowns, inlays, bridges, and periodontics). For more information, call Aetna at 1-877-238-6200 or visit the Aetna website.When you sign up for a GEHA dental plan, you get the power to verify whether a service is covered — and estimate how much it will cost in 2023 or 2024. Understanding and comparing treatment costs may help you make better decisions about your dental care. ... Schedule a benefits session; Text now 816.219.6184; Are you a current GEHA member ... 1-800-531-7895 (TTY: 711) News for you. We’ve enhanced the dental portal. Improvements include easier navigation, an expanded benefits search function and an expanded code search function. Our new user-friendly, provider-centered improvements can help minimize and optimize your daily tasks. Some of the new features include: for 2024, MetLife will provide you with a confirmation letter only. If you were enrolled in the MetLife Federal Dental Plan in 2023 and continue coverage. (877) 638-3379 to confirm your enrollment in the Plan and the benefits available to you. benefits nor does your provider need it to render dental services.On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announces finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2024.The amounts established by the DHS are published in fee schedules, available to all providers and other interested parties. This information is intended to help you understand the Wisconsin BadgerCare Plus Maximum Allowable Fee Schedule. If you have questions, please contact Provider Services at (800) 947-9627.2023. Who may enroll in this Plan: All Federal employees, annuitants, and certain TRICARE beneficiaries in the United States and overseas who are eligible to enroll in the Federal Employees Dental and Vision Insurance Program. This Plan has five enrollment regions, including international; please see the end of this brochure to determine your ...These 2023 base rates reflect the market basket update as well as other adjustments, such as adjustments for budget neutrality which vary by facility type. As seen above, CMS increased the ASC base rate from $49.92 in 2022 to $51.85 in 2023. This represents a +3.9% increase in the base rate for all ASC services in 2023. 1. Under the DMO dental plan, services performed by specialists are eligible for coverage only when prescribed by the primary care dentist and authorized by Aetna Dental. If Aetna's payment to the specialty dentist is based on a negotiated fee, then the member's copayment for the service will be based on the same negotiated fee. 2. So you want your pearly whites to be pearlier and whiter, but how much does teeth whitening cost? Are there cheap methods? Find out here. Eisdorf Dental Group Eisdorf Dental Group ...

Your rights and protections against surprise medical bills. When you get emergency care or you're treated by an out-of-network provider at an in-network hospital, or ambulatory surgical center or by an air ambulance provider, you are protected from surprise billing or balance billing. Federal No Surprises Bill Act Disclosure - English (PDF)

Teething is something every baby goes through, but teething pain and discomfort can unsettle your little one. There are several remedies to help soothe them. Try our Symptom Checke... Dental care is a vital part of maintaining your health and well-being, especially as you age. And one of the main perks of joining a Medicare Advantage (MA) plan is that many plans offer dental coverage to help you keep up with your oral health. Original Medicare, on the other hand, does not cover routine dental care, such as cleanings, X-rays ... A $20 processing fee will be applied at checkout. Aetna Dental Access. Aetna Dental Access® plan provides members with, in most instances, 15-50%* per visit savings ... Site of service for outpatient surgical procedures policy. Our precertification program is aimed at minimizing members’ out-of-pocket costs and improving overall cost efficiencies. It requires that the more cost-effective site of service is used for certain outpatient surgical procures, when clinically appropriate.Market Basket base rate increased by 4.1% to $10,840.00. The outlier threshold for 2023 is $79,500.00. Long Term Care Hospital (LTCH) Fee Schedule. Fee Schedule is based on Diagnosis Related Groups (DRGs) Market Basket base rate increased by 4.1% to $242,450. The outlier threshold for 2023 is $140,000.A significant step toward better dental health. Fee schedule dental insurance from Colonial Life covers a wide range of treatments and provides a fixed benefit amount for covered dental procedures, making it a great fit for individuals and families. Orthodontic and vision coverage may be available as optional riders.Your rights and protections against surprise medical bills. When you get emergency care or you're treated by an out-of-network provider at an in-network hospital, or ambulatory surgical center or by an air ambulance provider, you are protected from surprise billing or balance billing. Federal No Surprises Bill Act Disclosure - English (PDF)Send dental network inquiries to Aetna Dental West, 21215 Burbank Blvd., Suite 620, Woodland Hills, CA 91367 or fax to 1-866-445-4387. Attn: 2024 provider enrollment. For dental network questions, call 1-800-451-7715 (TTY: 711).

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UnitedHealthcare Commercial Dental Provider Manual — 2023 iii ... fee schedules, benefit information, provider search and much more 24 hours a day, seven days a week . We also have a self-service feature that allows your office to validate, change and attest to your office information online . WeYou get quick implementation and integration with other Aetna solutions. You save with best in-market pricing, at around $3,700 ROI for each consult. We'll issue reports on program use, satisfaction and cost savings. Second Opinion is available for self-funded medical customers. Your Aetna rep can tell you more.Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans contain exclusions and limitations. Health care providers, learn more about health insurance exchanges and get answers to ...Call us. Talk to a licensed agent at. 1-855-335-1407 (TTY: 711) Monday to Friday, 8 AM to 8 PM. Medicare FAQs. Get answers to common Medicare questions. With Aetna Medicare Advantage PPO plans, you can visit any doctor in or out of our provider network who accepts Medicare and our plan terms.This Aetna Dental® Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance ... on a negotiated fee schedule. When emergency services are provided by a non-participating dentist, you will be ... CALIFORNIA INSTITUTE OF TECHNOLOGY Effective Date: 01-01-2023 Dental Benefits Summary details. Subject to …Your Aetna dental plan options include: Affordable plan options starting at $20 with dental checkups, cleanings and x-rays covered at 100% ; A nationwide network of more than 420,000 dental providersBased on August 2022 Aetna provider data; Plan options with coverage for fillings, crowns, root canals and moreUpdated Fee Schedule 2023 [ 537.2 kB ] Effective 1/1/2023 Updated XLS 2023 Effective [ 53 kB ] 1/1/2023 Promulgated Fee Schedule [ 592.7 kB ] July 2022 Promulgated XLS [ 114.4 kB ] July 2022: Prescribed Drugs Immunization Fee ScheduleCorporate headquarters. For general inquiries, reach our corporate headquarters at 1-888-US-AETNA ( 1-800-872-3862) (TTY: 711). There is no option for members to get information at this number. The corporate headquarters phone lines are staffed: Monday through Friday, 8 AM to 6 PM ET.This Aetna Dental® Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. Under the Dental Preferred Provider Organization (PPO) plan, you may choose at the time of service either a PPO participating dentist or any nonparticipating dentist. High Option for additional protection from unexpected dental costs: NEW! Reduced rates for our High option. Unlimited annual maximum per person. Adult orthodontia covered at 70% up to a plan lifetime maximum of $3,000. Child orthodontia covered at 70% up to a plan lifetime maximum of $5,000. Standard Option. ….

Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, is the discount medical plan organization. For more information, call 1-877-698-4825 or visit www.vitalsavings.com. Oklahoma form numbers for discount programs are: GR-96402-02 04-09.FEE SCHEDULES. The information contained in these schedules is made available to provide information and is not a guarantee by the State or the Department or its employees as to the present accuracy of the information contained herein. Hospital Rates and Revenue Codes *. Maximum Reimbursement Rates for Organ Transplant Procedures and ...Beginning June 1, 2023, you may see new claims edits. These are part of our CCRP. ... No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. ... Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental ...The calendar year (CY) 2023 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation. Background on the Physician Fee Schedule. Since 1992, Medicare payment has been made under the PFS for ...Cost estimator and fee schedules · Pharmacy claims ... Aetna - Health Insurance Plans & Dental Coverage ... Unless noted, all updates become effective on March 1, ....Training materials will be released in the summer of 2023 and will be posted on our Medicare page. ... No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. ... Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not ...We would like to show you a description here but the site won't allow us.The calendar year (CY) 2023 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation. Background on the Physician Fee Schedule. Since 1992, Medicare payment has been made under the PFS for ... Aetna dental fee schedule 2023, Aetna Medicare Advantage HMO plan ..... 52 Aetna Medicare Advantage PPO plan 52 Home assessment program 53 Quality improvement program 53 ... Fee schedules ..... 74 Provider services ..... 74 Complaints and grievances ..... 74. 4 . don't, the terms of your agreement override this manual. ..., What is the fee schedule of maximum allowable c harges? By joining, you accept our allowable charges as payment in full when treating members. The fee schedule lists the total includes payments from us and applicable member payments. How will I know if a patient is eligible for Aetna Dental PPO benefits? We ask that PPO patients, Dental benefits. Plans that offer benefits through a network cover preventive care such as oral exams, cleanings and X-rays.*. Some plans include comprehensive services such as fillings and extractions. You can find specific benefit information in the Evidence of Coverage. Plans that offer DMR benefits cover most dental procedures, including ..., You pay your coinsurance or copay along with your deductible. Some plans do not offer any out-of-network benefits. For those plans, out-of-network care is covered only in an emergency. Otherwise, you are responsible for the full cost of any care you receive out of network. The information on this page is for plans that offer both network and ..., This Article gives a summary of the policies in the CY 2023 MPFS. CMS issued the 2023 Physician Fee Schedule final rule updating payment policies and Medicare payment rates for services we pay providers under the MPFS in CY 2023. The final rule also addresses public comments on Medicare payment policies proposed earlier this year., D1354. Application of caries arresting medicament – per tooth. 27. All. 11, 12, 31, 32, 99. $25.00. No. 1 per tooth per day, maximum of 10 teeth per day, 4 times per tooth per year, 6 times per tooth per lifetime (Under 21 years of age only) T., , Dental Fee Schedule admin 2017-08-16T11:04:19-04:00. Download (PDF, 159KB) Archives. December 2023 (2) October 2023 (2) August 2023 (1) June 2023 (2) April 2023 (1) January 2023 (2) November 2022 (5) October 2022 (1) September 2022 (1) August 2022 (2) July 2022 (2) June 2022 (2) May 2022 (3), This brochure describes the benefits of Aetna Dental under Aetna Life Insurance Company’s contract OPM02-FEDVIP-02AP-01 with OPM, as authorized by the FEDVIP law. The address for our administrative office is: Aetna Dental Federal Plans PO Box 550 Blue Bell, PA 19422-0550. 1-800-537-9384 www.aetnafeds.com, This is what you pay for out-of-network providers. Inpatient Mental Health Care. $200 per day, days 1-7; $0 unlimited additional days. 30% per stay. The member cost sharing applies to covered benefits incurred during a member's inpatient stay. Outpatient Mental Health Care. Individual visit. $40. 30%., Aetna Better Health of Maryland is part of Aetna® and the CVS Health® family, one of our country's leading health care organizations. We've been serving people who use Medicaid services for over 30 years — from kids, adults and seniors to people with disabilities or other serious health issues. Our national experience helps us do lots ..., Dental procedure codes not listed on this schedule will be discounted at 20% off the General Dentist's normal fee at the time of service. Participating Specialists (Board Certified or Advanced Degree) do not charge according to a fee schedule. Participating Specialists will give a 20% discount off of their normal fees., Expedited medical exceptions. In certain circumstances*, you or your prescriber can request a medical exception for a non-covered drug. To submit a request, call our Precertification Department at 1-855-582-2025 (TTY: 711), or fax a request to 1-855-330-1716.You also can mail a written request to Aetna PA, 1300 E. Campbell Rd., Richardson, TX 75081., To use a general fee schedule, Medicaid providers can click Static Fee Schedules. The fee displayed is the allowable rate for this service. Since September 1, 2011, the Online Fee Lookup (OFL) and static fee schedules include a column titled "Adjusted Fee." The Adjusted Fee column displays the fee with all of the percentage reductions applied., On March 9, 2024, President Biden signed the Consolidated Appropriations Act, 2024, which included a 2.93 percent update to the CY 2024 Physician Fee Schedule (PFS) Conversion Factor (CF) for dates of service March 9 through December 31, 2024. This replaces the 1.25 percent update provided by the Consolidated Appropriations Act, 2023, therefore the CY 2024 CF for dates of service January 1 ..., Nippon Life Insurance Company of America® - marketing name Nippon Life Benefits®, NAIC number 81264, licensed & authorized in all states plus DC, except not ME, NH or WY, domiciled in Iowa, with a principal place of business at 666 Third Avenue, Suite 2201, NY, NY 10017-9113, member company of Nippon Life Insurance Company of Japan ("Nissay")., Part I: GENERAL INFORMATION. Insurer Name: Aetna Life Insurance Company Policy Type: PPO Effective Date: 01/01/2023-12/31/2023. Plan Name: Aetna Dental® PPO Insurer Phone #: 1-877-238-6200 Insurer Website: www.aetna.com. THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND WHAT YOU WILL PAY FOR COVERED SERVICES., Expedited medical exceptions. In certain circumstances*, you or your prescriber can request a medical exception for a non-covered drug. To submit a request, call our Precertification Department at 1-855-582-2025 (TTY: 711), or fax a request to 1-855-330-1716.You also can mail a written request to Aetna PA, 1300 E. Campbell Rd., Richardson, TX 75081., Last Date of Update 12/18/2023. Providers ... Welcome to the LIBERTY Dental Plan Resource Library. To download a form or user guide, please select your state and then ..., Aetna Clinical Policy Bulletins. Our Clinical Policy Bulletins (CPBs) explain the medical, dental and pharmacy services we may or may not cover. They are based on objective, credible sources, such as the scientific literature, guidelines, consensus statements and expert opinions. Medical Clinical Policy Bulletins. Dental Clinical Policy Bulletins., However, behavior modification and dental or medical treatment options (e.g., prosthodontics) seem to be promising treatment approaches. At present, a 2-step assessment process, consisting of dental screening followed by behavioral assessment, can be recommended. Lee et al (2010) evaluated the effect of botulinum toxin type A on nocturnal bruxism., Find out about all of the resources available to health care professionals and learn how to join the Aetna providers network., You may request the top 100 billed codes related to your specialty or the full fee schedule listing by checking one of the boxes below. Please note that the full fee schedule listing contains over 10,000 codes across all specialties in the Horizon Blue Cross Blue Shield of New Jersey Networks and therefore, we recommend that you request the codes for your individual specialty first., Apr 1, 2024 · Physician Fee Schedule Look-Up Tool. To read more about the MPFS search tool, go to the MLN® booklet, How to Use The Searchable Medicare Physician Fee Schedule Booklet (PDF) . Page Last Modified: 04/01/2024 08:38 AM. Help with File Formats and Plug-Ins. , If you have any questions, please contact Leigh Ann Moore (OAMR) at 304-356-4916. Fee Schedule Updates. The following fee schedules will now be effective April 1st through March 31st starting in calendar year (CY) 2019: Physician's (RBRVS) Fee Schedule. Clinical Lab Fee Schedule., Department of Vermont Health Access. 280 State Drive, NOB 1 South Waterbury, Vermont 05671-1010 Phone: 802-879-5900 Fax: 802-241-0260. Questions about your health coverage?, Emergency Dental Care. If you need emergency dental care for the palliative treatment (pain relieving, stabilizing) of a dental emergency, you are covered 24 hours a day, 7 days a week. When emergency services are provided by a participating PPO dentist, your co-payment/coinsurance amount will be based on a negotiated fee schedule., The Ontario government does not directly grant funds to individuals for private dental work. However, various programs supported by the province allow you to receive dental treatme..., Starting June 1, 2023, all prior authorization requests need to be submitted electronically. ... Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. ... No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in ..., Members and theirs providers becoming what to discuss the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Learn about fee schedule updates required all plans in your market. Beginning October 15, 2023, we'll adjust is standard feind planning (the Aetna® ..., Yes. Your plan may have one or both of these age limits: Orthodontic age limit: When the plan includes an orthodontic age limit, braces must be placed on your teeth before reaching your plan's specified age limit. Dependent age limit: Orthodontic benefits will be available until your dependent reaches your plan's specified age limit.No benefits will be paid after that, even if the treatment is ..., Ambulatory Surgical Center Facility Fees. Exhibit1A Final EO2 Version. Dental Fee Schedule. Exhibit2 Final EO2 Version. Private Nursing Care (per hour) Exhibit3 Final EO2 Version. Ambulance Services Fee Schedule. Exhibit4 Final EO2 Version. Durable Medical Equipment, Prosthetics, Orthotics Supplies., Site of service for outpatient surgical procedures policy. Our precertification program is aimed at minimizing members’ out-of-pocket costs and improving overall cost efficiencies. It requires that the more cost-effective site of service is used for certain outpatient surgical procures, when clinically appropriate.