CMS delays start dates for ASC prior authorization demonstration

Editor's Note

The Centers for Medicare & Medicaid Services (CMS) has delayed the start date for the ambulatory surgery center (ASC) prior authorization demonstration that affects ten states. This delay shifts the date previously set for December 15, 2025, and sets two different phases across affected states into 2026, according to a November 21 news release from the Ambulatory Surgery Center Association (ASCA).

The demonstration project impacts the following 10 states: Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee and Texas. Providers in California, Florida, Georgia, Maryland, New York, Pennsylvania and Tennessee can submit prior authorization requests beginning on January 5, 2026, for dates of service on or after January 19, 2026. Providers in Arizona, Ohio and Texas can submit prior authorization requests beginning on February 2, 2026, for dates of service on or after February 16, 2026, per the news release. It was also noted in the news release that in October 2025, ASCA sent a letter to CMS requesting a delay due to concerns including the capacity for MACs to handle the volume of prior authorization requests.

This prior authorization demonstration project was proposed by CMS in February 2024 to require that ASC providers submit documentation to their Medicare Administrative Contractors (MAC) to show that— prior to rendering a service—the service meets applicable Medicare coverage, coding, and payment rules. Specifically, as noted in the news release, there are 41 codes that will be subject to the demonstration. These codes fall under the following categories:
*Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair
*Botulinum Toxin Injection
*Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (including Lipectomy), and related services
*Rhinoplasty, and related services
*Vein Ablation, and related services