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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

ASC Prior Authorization

Ambulatory Surgical Center (ASC) Services

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: 10.03.2025

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