Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services - JE Part B
Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services
On December 15, 2025, CMS will start a prior authorization demonstration for certain ambulatory surgical center (ASC) services provided in ten states. California (CA) is currently the only state within JE included in this demonstration.
This demonstration applies to Medicare-enrolled ASCs in participating states that provide applicable services billed to Part B with place of service code 24, type of service F, and specialty code 49 (ASC Facility Usage for Surgical Services). Additionally, the demonstration applies to ASCs located in the following states: California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia, and New York.
Prior authorization is optional for the ASC demonstration. However, if the prior authorization process is bypassed, applicable ASC claims will be subject to prepayment review.
ASC Prior Authorization Demonstration Service Categories
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
This program applies to:
- Certain procedures specified by CMS that take place in an ASC billed to part B.
- ASCs located in the states of California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia, or New York.
This program does NOT apply to:
- ASC services provided outside of California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia, or New York.
- Prescription drugs - Contact beneficiary's Part D insurance for further assistance.
- Repetitive Scheduled Non-Emergent Ambulance transport (RSNAT) - RSNAT is a separate program
- Oxygen or home medical equipment - These are DME requests
- Radiology tests (MRIs, CTs, X-Rays) - There is currently no division within Noridian that does prior authorization for radiology testing.
Resources
- Prior Authorization for Certain Ambulatory Surgical Center (ASC) Services (CMS)
- Prior Authorization Ambulatory Surgical Center Demonstration FAQs
- Certain Ambulatory Surgical Center (ASC) Services Operational Guide
- List of Ambulatory Surgical Center Services for Prior Authorization
Contact Us
For questions, please contact PartBpriorauth@noridian.com
