A five-year prior authorization demonstration for certain procedures in ambulatory surgery centers (ASCs), initially scheduled to begin in December 2025, has been postponed.
New Timeline: Phased Start in Early 2026
The rollout will now take place in two phases. ASCs in some states can begin submitting prior authorization requests on January 5, 2026 for procedures performed on January 19, 2026 and after. Others must wait until February 2, 2026 for services dated February 16, 2026 or later.
Why the Delay and What It Signals
The delay follows concerns raised by ASC stakeholders over administrative readiness. Prior authorization and pre-claim review programs have a long track record of complexity and operational burden, creating skepticism before the program’s launch.
This is not CMS’s first postponement. Previous review and authorization efforts have been repeatedly delayed or restructured because of shifting timelines, unclear guidance, and contractor readiness issues.
What ASC Operators and Revenue Cycle Teams Should Monitor
- Any ASC that opts out of prior authorization under the demonstration may face prepayment medical review for covered services, increasing the risk of payment delays or denials.
- Documentation and compliance workflows must be reviewed now to ensure quick adaptation when the new timeline begins. Missing or incomplete documentation is a leading cause of authorization delays or denials.
- Coordination among scheduling, clinical documentation, billing, and administrative teams will be essential to support smooth submissions once the program activates.
What This Means for the ASC Landscape
The delay highlights how difficult it is to operationalize regulatory changes, especially in high-volume outpatient environments. For now, the postponement gives ASCs and surgical practices a brief window to prepare and realign workflows.
From a revenue cycle and coding perspective, the impact on billing processes, authorization workload, claim timelines, and cash flow could be significant once the program launches in early 2026.
