Medical review
Ambulatory surgical center (ASC) prior authorization request (PAR) submission guidelines
View these submission guidelines for ASC prior authorization requests.
2025 jurisdiction list for DMEPOS HCPCS codes
CMS annually updates the durable medical equipment prosthetics, orthotic, and supplies (DMEPOS) for DME MAC and Part B MAC jurisdictions list.
Repetitive scheduled non-emergency ambulance transport prior authorization claims submission guidelines
Follow this instructions to learn how to file a claim once you received the unique tracking number (UTN) related to the prior authorization of repetitive, scheduled non-emergency ambulance transports…
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Prior authorization (PA) demonstration for certain ambulatory surgical center (ASC) services
CMS is delaying the start date for the PA demonstration for certain services provided in ASCs and will be implementing the demonstration in two phases. For more information on the delayed…
Ambulatory surgical center (ASC) prior authorization (PA) claim submission guidelines
Prior authorization (PA) for the ASC prior authorization demonstration is voluntary. However, if a provider elects to bypass PA, applicable ASC claims will be subject to prepayment medical review.
Prior authorization request (PAR) ambulatory surgical center (ASC) procedures Medicare Part B fax/mail coversheet
The PAR fax/mail coversheet for ASCs is now available for Florida ASCs participating in the ASC PA demonstration. ASCs in Florida can submit PARs beginning on January 5, 2026, for dates of service (…
Targeted probe and educate (TPE) round results: Evaluation and management services - outpatient office visits
View TPE round results for evaluation and management services - outpatient office visits.
Targeted probe and educate (TPE) round results: Evaluation and management services – initial inpatient care visits and subsequent inpatient care visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services - initial inpatient care visits and subsequent inpatient care visits TPE round results.