CMS Announces Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services

The Centers for Medicare & Medicaid Services (CMS) announced a five-year prior authorization demonstration project for select Ambulatory Surgical Center (ASC) services. The demonstration will begin on December 15, 2025, and will be tested in New York, Georgia, Maryland, Pennsylvania, Tennessee, Ohio, Arizona, Texas, Florida, and California. While submitting for prior authorization will technically be optional, prepayment review could result in nonpayment for services that are later deemed ineligible.

The following service categories will be included:

• Blepharoplasty
• Botulinum toxin injections
• Panniculectomy
• Rhinoplasty
• Vein ablation procedures

While the codes for selected services do not directly affect anesthesia services, anesthesiologists may still be indirectly affected. As CMS notes in its frequently asked questions, “associated/related (professional) services will be denied when there was a non-affirmation prior authorization request decision for the ASC service(s), or when the ASC facility claim was denied after prepayment review. These associated services include but are not limited to services such as anesthesiology services and/or physician services.”

Anesthesiologists who practice in ASCs in the ten selected states should check with their ASCs to ensure that prior authorization is being submitted for the services included in this demonstration.

Please contact the ASA Department of Quality and Regulatory Affairs at [email protected] with any questions.