Lexology April 25, 2024
Ambulatory surgery centers (ASCs) in 10 states are set to face new prior authorization requirements from the Centers for Medicare & Medicaid Services (CMS) related to coverage for certain procedures in order to confirm medical necessity. CMS has proposed implementing a five-year demonstration project (the Demonstration) to target the procedures of blepharoplasty (eyelid lift), botulinum toxin injections (neurotoxin injections), rhinoplasty (nose repair), panniculectomy (abdominal wall contouring) and vein ablation (treatment for varicose veins) performed in ASCs (the Procedures). This Demonstration will require ASCs in Florida, New York, Tennessee, California, Texas, Arizona, Pennsylvania, Ohio, Maryland and Georgia to either submit a prior authorization request and obtain a provisional affirmation before providing the service or be subject to prepayment review, which could...
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