Centene is the latest national insurer to roll out a prior authorization gold card program, joining UnitedHealthcare and Humana. For ASCs, the catch is where the exemption lands: in most programs, the gold card belongs to the surgeon’s practice, not the surgery center.
Here are eight things ASC leaders should know:
1. Centene’s program starts in November. The insurer said Oct. 13 its National Performance-Based Gold Card Program will first cover more than 160,000 qualifying providers for some outpatient services. Eligibility rests on approval history, documentation quality, medical policy compliance and regulatory adherence. Gold-carded providers will use a pre-notification process instead of standard review, and Centene plans to add services and providers over time. Centene has not publicly listed which outpatient services qualify.
2. UnitedHealthcare’s program is entering its third year. UnitedHealthcare launched the first national gold card program in October 2024. It applies across its commercial, individual exchange, Medicare Advantage and community plans. Qualifying groups submit an advance notification that confirms eligibility and network status, with no clinical information requested, according to UnitedHealthcare. The newest qualifying cycle took effect Oct. 1.
3. The UnitedHealthcare bar is high, and the code list is shrinking. To qualify, a group needs at least 10 prior authorizations a year on gold card codes for two straight years, with an approval rate of 92% or higher after appeals. The original list held about 500 CPT codes. UnitedHealthcare had cut 36 of them by early 2026 and added none. Some removals reflect codes that no longer need prior authorization at all.
4. Humana’s program is built for physicians. Humana said in July 2025 it would launch a national gold card program in 2026. In an August news release, Humana said it still has plans to launch the program in 2026. It will waive prior authorization for certain items and services for providers whose requests consistently meet medical criteria. Humana also says it removed prior authorization from more than 340 codes across 2024 and 2025.
5. The gold card follows the surgeon’s group, not the ASC. UnitedHealthcare measures prior authorization volume at the provider group’s tax ID level. The ordering provider’s NPI tied to a gold card tax ID is what qualifies. Centene and Humana also frame eligibility around providers and physicians. For ASCs, the benefit depends on whether their surgeons’ practices have earned gold card status, which centers can ask their groups directly.
6. Site-of-service prior authorization is a separate hurdle. Some payer prior authorizations steer cases toward the ASC rather than question the procedure. UnitedHealthcare’s commercial and exchange plans require prior authorization for more than 100 ophthalmology codes when performed in a hospital outpatient department. The insurer’s initial gold card rollout included no ophthalmology services. The American Academy of Ophthalmology urged UnitedHealthcare to add them.
7. Medicare is adding prior authorization for ASCs, not removing it. CMS began a five-year demonstration requiring prior authorization for certain ASC services in 10 states in early 2026, after delaying its December 2025 start. Targeted services include blepharoplasty, blepharoptosis repair, brow ptosis repair and botulinum toxin injections. The Outpatient Ophthalmic Surgery Society has argued that ASCs typically don’t hold the patient records prior authorization requires, and that the treating practice should carry that responsibility. Separately, CMS’ WISeR model began Jan. 1 in six states, targeting 17 services that include arthroscopic knee procedures, epidural steroid injections and lumbar decompression.
8. State gold card laws add another layer. At least 10 states require insurers to run gold card programs. Texas passed the first comprehensive law in 2021, though it applies only to state-regulated plans, roughly one-fifth of that state’s market. Only about 3% of Texas physicians have earned gold card status, according to the Texas Department of Insurance. In 2025, Arkansas extended gold card status to a provider’s group practice and Texas lengthened its look-back period to one year. UnitedHealthcare also launched a separate Georgia gold card program July 1.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
