Medical review
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: Surgical services - nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127)
View targeted probe and educate (TPE) round results for nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127).
Targeted probe and educate (TPE) round results: Surgical services - nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127)
View targeted probe and educate (TPE) round results for nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127).
Targeted probe and educate (TPE) round results: Psychotherapy services (CPT 90832, 90834, 90837)
View TPE round results for psychotherapy services.
Targeted probe and educate (TPE) round results: Psychotherapy services (CPT 90832, 90834, 90837)
View TPE round results for psychotherapy services.
Targeted probe and educate (TPE) round results: End stage renal disease (ESRD) (CPT 90960)
View targeted probe and educate (TPE) round results for end stage renal disease (ESRD).
Targeted probe and educate (TPE) round results: End stage renal disease (ESRD) (CPT 90960)
View targeted probe and educate (TPE) round results for end stage renal disease (ESRD).
Targeted probe and educate (TPE) round results: Wound debridement
View TPE round results for wound debridement (CPT 11102-11103, 11200-11201, 11300-11303, 11305-11313 and 11401-11406, 11421-11424, 11426, 11440-11446).
Targeted probe and educate (TPE) round results: Wound debridement
View TPE round results for wound debridement (CPT 11102-11103, 11200-11201, 11300-11303, 11305-11313 and 11401-11406, 11421-11424, 11426, 11440-11446).