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Prior Authorization

Prior Authorization

The pages below:

  • Outline prior authorization processes for specific CMS programs, models, and demonstrations
  • Identify certain services that require prior authorization
  • Describe how to submit a prior authorization request
  • Provide links to request forms, coverage and documentation requirements, and other resources

OPD Prior Authorization

Hospital Outpatient Department (OPD) Services

RSNAT

Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT)

OPD Prior Authorization

Wasteful and Inappropriate Service Reduction (WISeR) Model


Updated: 09.29.2025

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