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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 ruleExternal PDF or CMS websiteExternal 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 instructionExternal PDF or CMS websiteExternal PDF for more information.

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