---
kind: "section"
citation: "42 C.F.R. § 416.65"
title: "42"
number: "416.65"
heading: "Covered surgical procedures."
url: "https://uscodex.org/cfr/42/416.65"
---

# §416.65. Covered surgical procedures.


Effective for services furnished before January 1, 2008, covered surgical procedures are those procedures that meet the standards described in paragraphs [(a)](#a) and [(b)](#b) of this section and are included in the list published in accordance with [paragraph (c)](#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;
  - (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 [§ 411.15](/cfr/42/411.15.md) 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.

## Notes

### Amendments

[47 FR 34094, Aug. 5, 1982, as amended at 71 FR 68226, Nov. 24, 2006]

### Authority

Authority: 42 U.S.C. 273, 1302, 1320b-8, and 1395hh.

### Source

Source: 47 FR 34094, Aug. 5, 1982, unless otherwise noted.

### Amendments

[47 FR 34094, Aug. 5, 1982, as amended at 71 FR 68226, Nov. 24, 2006]