Medicare’s Prior Authorization Demonstration for Certain Ambulatory Surgical Center (ASC) Services is part of CMS’s broader effort to crush fraud and protect the Medicare Trust Fund. 

• Providers in California, Florida, Tennessee, Pennsylvania, Maryland, Georgia, and New York can submit prior authorization requests beginning on January 5, 2026, for dates of service on or after January 19, 2026.
• Providers in Texas, Arizona, and Ohio can submit prior authorization requests beginning on February 2, 2026, for dates of service on or after February 16, 2026.

The goal: reduce improper payments while ensuring that beneficiaries still receive medically necessary care without adding new documentation requirements.

How It Works

• Same documentation, earlier in the process: You’ll provide the same medical necessity documentation you already submit, just sooner.
• Voluntary participation: Providers can opt into prior authorization. If you bypass it, claims for targeted services will undergo prepayment medical review instead.
• Reduced appeals: By resolving issues upfront, providers may avoid denials and lengthy appeals.
• Fraud prevention: CMS specifically designed this program to prevent overuse of cosmetic procedures billed to Medicare.

Targeted ASC Service Categories

The demonstration includes select cosmetic and reconstructive services, such as:

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

Download the List of Ambulatory Surgical Center Services For Prior Authorization

Why It Matters for ASC Providers

• Protect your revenue: Denied claims cost your ASC time and money. Prior authorization helps safeguard reimbursement.
• Minimize compliance risk: Demonstrating medical necessity upfront reduces exposure during audits.
• Maintain patient trust: Patients are less likely to experience delays in care due to post-service claim disputes.

Peregrine’s Take

At Peregrine Healthcare, we see prior authorization not as another administrative burden but as a revenue protection strategy. By proactively managing documentation and payer compliance, ASCs can avoid unnecessary revenue leakage and keep the focus where it belongs: on patient care.

Next Step: If your ASC is impacted by this demonstration, our team can help you streamline your prior authorization process, reduce denials, and protect your bottom line.

Call us at 877-463-1110 to speak with our authorization and claims workflow experts.