On Dec. 15, CMS will launch a five-year prior authorization demonstration for certain ASC services in California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia and New York.
According to a Sept. 3 CMS notice, the targeted procedure categories include:
- Blepharoplasty
- Botulinum toxin injections
- Panniculectomy
- Rhinoplasty
- Vein ablation procedures
ASCs may begin submitting prior authorization requests on Dec. 1, 2025, for dates of service on or after the Dec. 15 start date.
The CMS notice clarified that prior authorization is voluntary under the demonstration. However, facilities that choose not to participate will have applicable ASC claims subject to prepayment medical review.
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.