Digital Debut

CMS Delays Start Date for ASC Prior Authorization Demonstration

ASCs in 10 states will be affected by this project

BY KARA NEWBURY | NOVEMBER 21, 2025

The Centers for Medicare & Medicaid Services (CMS) has delayed the start date for the ASC prior authorization demonstration and will implement the demonstration in two phases. CMS had previously announced the demonstration would start on December 15, 2025. The demonstration project impacts the following 10 states: Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee and Texas.

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

ASCs in the impacted states must submit documentation to their Medicare Administrative Contractors (MAC) that shows a service meets applicable Medicare coverage, coding and payment rules prior to performing the service.

There are 41 codes that will be subject to the demonstration, which fall within the following categories:

• Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair
• Botulinum Toxin Injection
• Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (including Lipectomy), and related services
• Rhinoplasty, and related services
• Vein Ablation, and related services

CMS first proposed this demonstration project in February 2024. Last month, ASCA sent a letter to CMS requesting a delay of the scheduled start date. In the letter, ASCA noted the ongoing government shutdown and possible implementation struggles for MACs, an issue that was seen when prior authorization was first implemented for hospital outpatient departments (HOPD).

More information is available in CMS’ operational guide and frequently asked questions document.

Listen to an ASCA Audio Update on the demonstration project.

Write Kara Newbury with any questions.