December 10, 2024
Prior Authorization Changes
CMS instructed the A/B Medicare Administrative Contractors (MACs) to implement changes to the prior authorization programs.
Prior Authorization for Certain Hospital Outpatient Department Services
Effective January 1, 2025, the timeframe for CGS to review a standard prior authorization request will change from 10 business days to 7 calendar days. The timeframe for expedited requests remains 2 business days.
See the final rule or CMS website for more information.
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Effective January 9, 2025:
- The timeframe for CGS to review a standard prior authorization request will change from 10 business days to 7 calendar days.
- The option to request an expedited prior authorization review will be removed. Prior authorization requests under this model are for non-emergent services that are scheduled in advance and do not meet the criteria for expedited review.
See the complete CMS instruction or CMS website for more information.