CMS Adult Elective Surgery and Procedures Recommendations: 

Limit all non-essential planned surgeries and procedures, including dental, until further notice 

To aggressively address COVID-19, CMS recognizes that conservation of critical resources such as 

ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of 

patients and staff to the SARS-CoV-2 virus. Attached is guidance to limit non-essential adult elective 

surgery and medical and surgical procedures, including all dental procedures. These considerations will 

assist in the management of vital healthcare resources during this public health emergency. 

Dental procedures use PPE and have one of the highest risks of transmission due to the close proximity 

of the healthcare provider to the patient. To reduce the risk of spread and to preserve PPE, we are 

recommending that all non-essential dental exams and procedures be postponed until further notice. 

A tiered framework is provided to inform health systems as they consider resources and how best to 

provide surgical services and procedures to those whose condition requires emergent or urgent 

attention to save a life, preserve organ function, and avoid further harms from underlying condition or 

disease. Decisions remain the responsibility of local healthcare delivery systems, including state and 

local health officials, and those surgeons who have direct responsibility to their patients. However, in 

analyzing the risk and benefit of any planned procedure, not only must the clinical situation be 

evaluated, but resource conservation must also be considered. These recommendations are meant to 

be refined over the duration of the crisis based on feedback from subject matter experts. At all times, 

the supply of personal protective equipment (PPE), hospital and intensive care unit beds, and ventilators 

should be considered, even in areas that are not currently dealing with COVID-19 infections. Therefore, 

while case-by-case evaluations are made, we suggest that the following factors to be considered as to 

whether planned surgery should proceed: 

• Current and projected COVID-19 cases in the facility and region. 

o Consider the following tiered approach in the table below to curtail elective surgeries. 

The decisions should be made in consultation with the hospital, surgeon, patient, and 

other public health professionals. 

• Supply of PPE to the facilities in the system 

• Staffing availability 

• Bed availability, especially intensive care unit (ICU) beds 

• Ventilator availability 

• Health and age of the patient, especially given the risks of concurrent COVID-19infection 

during recovery 

• Urgency of the procedure. 

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Tiers Action Definition Locations Examples 

Tier 1a Postpone 

surgery/ 

procedure 

Low acuity 

surgery/healthy 

patientoutpatient surgery 

Not life-threatening 

illness 

HOPD* 

ASC** 

Hospital with 

low/no COVID19 census 

-Carpal tunnel 

release 

-EGD 

-Colonoscopy 

-Cataracts 

Tier 1b Postpone surgery/ 

procedure 

Low acuity 

surgery/unhealthy 

patient 

HOPD 

ASC 

Hospital with 

low/no COVID19 census 

-Endoscopies 

Tier 2a Consider 

postponing 

surgery/procedure 

Intermediate acuity 

surgery/healthy 

patientNot life threatening 

but potential for 

future morbidity 

and mortality. 

Requires in-hospital 

stay 

HOPD 

ASC 

Hospital with 

low/no COVID19 census 

-Low risk cancer 

-Non urgent 

spine & Ortho: 

Including hip, 

knee 

replacement and 

elective spine 

surgery 

-Stable ureteral 

colic 

-Elective 

angioplasty 

Tier 2b Postpone surgery/ 

procedure if 

possible 

Intermediate acuity 

surgery/unhealthy 

patientHOPD 

ASC 

Hospital with 

low/no COVID19 census 

Tier 3a Do not 

postpone 

High acuity 

surgery/healthy 

patient 

Hospital -Most cancers 

-Neurosurgery 

-Highly 

symptomatic 

patients 

Tier 3b Do not postpone High acuity 

surgery/unhealthy 

patient 

Hospital -Transplants 

-Trauma 

-Cardiac w/ 

symptoms 

-limb 

threatening 

vascular surgery 

*Hospital Outpatient Department ** Ambulatory Surgery Center 

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