Authorization check · free
Does Medicare require prior authorization for this procedure — and what does the policy require?
Four Medicare programs require authorization for procedures: WISeR in AZ, NJ, OH, OK, TX, WA (2026–2031), the hospital outpatient department program nationwide, CMS’s ASC demonstration for ambulatory surgical centers in CA, FL, TN, PA, MD, GA, NY, TX, AZ, OH, and Medicare Advantageplan rules. All four decide on the same coverage policies. This check names the program, the decision clock and route, the governing policy as it stands today, whether the diagnosis is on its list, the policy’s own documentation requirements and, where WISeR applies, CMS’s documentation checklist from the WISeR Operational Guide — quoted, not summarised. 93 procedure codes across the three federal lists.
This check reports what the programs and the policy documents say. It never predicts whether a request will be affirmed — the reviewer reads the clinical notes, and no notes are sent here. Nothing about a patient is entered or stored. Browse the code lists below, or run the denial check after a denial.
Not covered by this check: the DMEPOS prior authorization process and the probationary process for newly enrolled DMEPOS suppliers; repetitive, scheduled non-emergent ambulance transport; the home health and inpatient rehabilitation facility review choice demonstrations. Codes are shown as numbers only, as CMS lists them. CPT® is a registered trademark of the American Medical Association.