Medicare Prior Authorization Expands to Ambulatory Surgical Centers

Medicare adds new preapproval rules for certain outpatient surgeries in 10 states.

Starting in December, Medicare will begin requiring prior authorization for certain procedures when performed in ambulatory surgical centers. Dreamstime/TCA

By Donna LeValley From Kiplinger’s Personal Finance

Medicare beneficiaries in 10 states will soon be participating in a new prior authorization program. The Centers for Medicare & Medicaid Services (CMS) is implementing a five-year demonstration project for prior authorization of certain services provided in Ambulatory Surgical Centers (ASCs), starting in December 2025. The targeted services are procedures that can be medically necessary, but could also be considered cosmetic procedures.