Resources
Expanding Surgical Site of Care
The Surgical Site of Care program will include additional procedures effective February 1, 2026 and in New York on April 1, 2026. Our program aims to improve the efficiency of healthcare delivery by ensuring procedures are conducted in the most appropriate setting for both patient safety and cost effectiveness.
*Procedure codes listed may vary by health plan
Order request checklists:
Wondering what information you’ll need to enter your order request? Download our checklist to learn more.
Surgical Clinical Review
- Surgical Procedures: Applicable Code List
- Surgical Appropriate Use Criteria: Site of Care
- Upper Gastrointestinal Endoscopy (Esophagogastroduodenoscopy)
*Note: Procedures reviewed may vary by health plan
Questions?
For questions related to an order request for a specific patient, contact Carelon Medical Benefits Management at 866-789-1456 for further assistance.
Call the Carelon provider portal support team at 800-252-2021 for help using provider portal.
Clinical Guidelines:
View the clinical criteria that guides our review process
Upper Gastrointestinal Endoscopy
Clinical Guidelines:
View the clinical criteria that guides our review process
Upper Gastrointestinal Endoscopy
Clinical Guidelines:
View the clinical criteria that guides our review process
Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures
Upper Gastrointestinal Endoscopy