February 10, 2026
Prior Authorization: Hospital OPD vs. ASC
CMS runs a variety of prior authorization and pre-claim review initiatives to help ensure compliance with Medicare rules, including:
- Prior Authorization for Certain Hospital Outpatient (OPD) Services
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center (ASC) Services
Although these initiatives are similar, the processes are separate and distinct. If you submit prior authorization requests (PARs), please ensure you’re using the correct information and resources as described below.
| Details | Hospital OPD | ASC |
|---|---|---|
| Program | Nationwide process | Includes selected states only |
| Jurisdiction | Includes Kentucky & Ohio | Includes Ohio (and other selected states) only Currently, providers in Kentucky don’t need to submit PARs. |
| Setting | Applicable services provided in a hospital OPD | Applicable services provided in an ASC |
| Requirement | Prior authorization is a condition of payment. | Prior authorization is voluntary. However, if you elect to bypass prior authorization, applicable ASC claims are subject to prepayment medical review. |
| Service Categories | Implemented July 1, 2020:
|
Dates of service on or after February 16, 2026:
|
| CPT/HCPCS Codes | Use the Final List of Outpatient Department Services That Require Prior Authorization These are the only codes that require prior authorization. Don’t report any other codes on the PAR form. |
Use the List of Ambulatory Surgical Center Services for Prior Authorization These are the only codes that require prior authorization. Don’t report any other codes on the PAR form. |
| PAR Submission Methods | Choose one:
|
Choose one:
|
| Form(s)* |
|
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| Resources | See OPD Prior Authorization Forms & Resources for a complete list. | See ASC Prior Authorization Forms & Resources for a complete list. |

