Medicare ASC prior authorization demonstration
ASC prior authorization demonstration: code list, states and rules
CMS’s demonstration covers 36 procedure codes in 5 service categories when furnished in an ambulatory surgical center in 10 states. Prior authorization is voluntary; a claim submitted without a decision is stopped for prepayment medical record review. From CMS’s list of ASC services for prior authorization (2026-03-05) and the ASC Operational Guide (March 3, 2026), checked 2026-09-17.
States and start dates
| State | Dates of service on or after | Medicare contractor |
|---|---|---|
| CA | 2026-01-19 | Noridian Healthcare Solutions, LLC (JE) |
| FL | 2026-01-19 | First Coast Service Options, Inc. (JN) |
| GA | 2026-01-19 | Palmetto GBA, LLC (JJ) |
| MD | 2026-01-19 | Novitas Solutions, Inc. (JL) |
| NY | 2026-01-19 | National Government Services, Inc. (JK) |
| PA | 2026-01-19 | Novitas Solutions, Inc. (JL) |
| TN | 2026-01-19 | Palmetto GBA, LLC (JJ) |
| AZ | 2026-02-16 | Noridian Healthcare Solutions, LLC (JF) |
| OH | 2026-02-16 | CGS Administrators, LLC (J15) |
| TX | 2026-02-16 | Novitas Solutions, Inc. (JH) |
Codes by service category
| Service category (CMS) | Codes | CMS note |
|---|---|---|
| Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair | 15820 15821 15822 15823 67900 67901 67902 67903 67904 67906 67908 | — |
| Botulinum Toxin Injection | 64612 64615 J0585 J0586 J0587 J0588 J0589 | — |
| Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy), and related services | 15830 15877 | 15847 was removed on January 1, 2026. |
| Rhinoplasty, and related services | 20912 21210 30400 30410 30420 30430 30435 30450 30460 30462 30465 30520 | — |
| Vein Ablation, and related services | 36473 36475 36478 36482 | 36474, 36476, 36479 and 36483 were removed on January 1, 2026. |
How a request is decided
How long does an ASC prior authorization decision take?
“The MAC will complete its review of medical records and send an initial decision letter that is either postmarked or faxed within 7 calendar days following the receipt of the initial request.”
ASC Operational Guide (March 3, 2026), §4.1 · CMS document
How fast is an expedited ASC request?
“If the MAC substantiates the need for an expedited decision, the MAC will make reasonable efforts to communicate a decision within 2 business days of receipt of the expedited request.”
ASC Operational Guide (March 3, 2026), §4.1 · CMS document
How long is an ASC decision valid?
“PAR decisions and UTNs for these services are valid for 120 days.”
ASC Operational Guide (March 3, 2026), §4.1.1 · CMS document
Is ASC prior authorization mandatory?
“Prior authorization is voluntary; however, the MAC will stop an applicable claim for standard Medicare prepayment medical record review if submitted without a PAR decision.”
ASC Operational Guide (March 3, 2026), §8.3 · CMS document
Is there an exemption (gold card) for the ASC demonstration?
“CMS will provide further information regarding exemption.”
ASC Operational Guide (March 3, 2026), §5 · CMS document
In a hospital outpatient department the same services fall under the hospital outpatient prior authorization program instead, in every state.
Check a procedure for your state, diagnosis and setting
Which program applies, the governing coverage policy as it stands today, whether the diagnosis is on its list, and the documentation the policy’s own text requires. Free; nothing about the patient is entered.
Run the check →Sources: CMS list of ASC services for prior authorization (2026-03-05) · ASC Operational Guide (March 3, 2026) · CMS demonstration page.
These pages report what CMS publishes. They never predict whether a request will be affirmed. Codes are shown as numbers only, as CMS lists them. CPT® is a registered trademark of the American Medical Association.