License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
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Prior Authorization

CMS runs a variety of prior authorization and pre-claim review initiatives to help ensure compliance with Medicare rules. Current initiatives that impact CGS Jurisdiction 15 providers include:

Prior Authorization Demonstration for Certain Ambulatory Surgical Center (ASC) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT)
Wasteful and Inappropriate Service Reduction (WISeR) Model

Although these initiatives are similar, each process is separate and distinct. Before you submit a prior authorization request (PAR), please ensure you're using the correct resources.

The comparison table below provides a summary or visit the dedicated webpages for complete details.

	ASC	Hospital OPD	RSNAT	WISeR
Program	Demonstration for selected states only	Nationwide	Nationwide	Innovation model for selected states only
Jurisdiction	Part B Ohio Note: Kentucky providers shouldn't submit PARs.	Part A Kentucky & Ohio	Part B Kentucky & Ohio	Part A; Part B Ohio Note: Kentucky providers shouldn't submit PARs.
Setting	Place of service 24, type of service F, and specialty code 49	Type of Bill 13X	Independent ambulance supplier transport	Hospital OPD (TOB 13X) ASC Physician's office Beneficiary's home Note: If the service is scheduled in a facility (OPD or ASC) setting, don't submit a PAR for the physician.
Process	Prior authorization is voluntary. If you don't submit a PAR before rendering the service or submitting a claim, applicable ASC claims are subject to prepayment medical review.	Prior authorization is a condition of payment. If you don't submit a PAR before rendering the service or submitting a claim, applicable OPD claims will deny.	Prior authorization is voluntary. If you don't submit a PAR before rendering the service or submitting a claim, applicable RSNAT claims are subject to prepayment medical review.	Prior authorization is voluntary. If you don't submit a PAR before rendering the service or submitting a claim, applicable claims are subject to prepayment medical review.
Dates of Service	On or after February 16, 2026	On or after July 1, 2020; July 1, 2021; or July 1, 2023	On or after August 1, 2022	On or after January 15, 2026
CPT/HCPCS Codes	List of Ambulatory Surgical Center Services for Prior Authorization Note: Prior authorization applies for these codes only. Don't report any other codes on the PAR form.	Final List of Outpatient Department Services That Require Prior Authorization Note: Prior authorization applies for these codes only. Don't report any other codes on the PAR form.	A0426 A0428 Note: Prior authorization applies for these codes only. Don't report any other codes on the PAR form.	Appendix A & Appendix B: WISeR Model Provider and Supplier Operational Guide Note: Prior authorization applies for these codes only. Don't report any other codes on the PAR form.
Associated Codes	Appendix B: ASC Services Operational Guide Note: These services will deny if the associated code on the ASC services list receives a non-affirmation decision or claim denial. Don't report these codes on the PAR form.	Appendix B: Hospital OPD Services Operational Guide Note: These services will deny if the associated code on the OPD services list receives a non-affirmation decision or claim denial. Don't report these codes on the PAR form.	A0425 Note: Payment for mileage is subject to recoupment if the transport code is denied. Don't report this code on the PAR form.	Appendix C: WISeR Model Provider and Supplier Operational Guide Note: These services will deny if the associated code in Appendix A receives a non-affirmation decision or claim denial. Don't report these codes on the PAR form.
PAR Submission Methods	myCGS portal (PA ASC form) Note: You must log in with an ASC account to access this form. Electronic Submission of Medical Documentation (esMD), content type 8.5* Fax* Mail*	myCGS portal (PA OPD form) Note: You must log in with a hospital OPD account to access this form. Electronic Submission of Medical Documentation (esMD), content type 8.5* Fax* Mail*	myCGS portal (PA Ambulance form) Note: You must log in with a Part B account to access this form. Electronic Submission of Medical Documentation (esMD), content type 8.5* Fax* Mail*	myCGS portal (PA WISeR form) Note: Facility Information auto-populates based on the user ID used to log in and can't be edited. If you can't log in with an account that matches the place of service, please fax your request. Electronic Submission of Medical Documentation (esMD), content type 8.5* Fax* Mail*
Form(s)* (esMD, fax, or mail submissions)	Prior Authorization: ASC forms Use the fax number or mailing address listed at the bottom. Note: Don't download and save for future use. For each request, access the appropriate form on our website, complete all required information online, save, and print.	Prior Authorization: OPD forms Use the fax number or mailing address listed at the bottom. Note: Don't download and save for future use. For each request, access the appropriate form on our website, complete all required information online, save, and print.	Prior Authorization: RSNAT (PAR 679) form Use the fax number or mailing address listed at the bottom. Note: Don't download and save for future use. For each request, access the form on the CGS or Innovaccer website, complete all required information online, save, and print.	WISeR Model Prior Authorization (PAR 457) form Use the fax number or mailing address listed at the bottom. Note: Don't download and save for future use. For each request, access the form on the CGS or Innovaccer website, complete all required information online, save, and print.
Resources	See ASC Prior Auth Forms & Resources for a complete list.	See OPD Prior Auth Forms & Resources for a complete list.	See Prior Authorization for RSNAT for a complete list.	See WISeR Model for a complete list.
Contact Information	Customer Service: 866.276.9558 Email: j15Bpriorautheducation@cgsadmin.com	Customer Service: 866.590.6703 Email: j15Apriorautheducation@cgsadmin.com	Customer Service: 866.276.9558 Email: j15Bpriorautheducation@cgsadmin.com	Innovaccer: 202.796.1619 Email: ohcmwiser-inquiry@innovaccer.com

Updated: 02.25.2026

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Prior Authorization

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