Health Law with Tara Ravi

Episode 2: CMS's Next Test Case: Prior Authorization for Specialty Surgery

11 min · 12. nov. 2025
episode Episode 2: CMS's Next Test Case: Prior Authorization for Specialty Surgery cover

Description

CMS is launching a five-year prior authorization demonstration for select outpatient procedures performed in ambulatory surgical centers. The program is limited to a few states — including Florida, Texas, Tennessee, and Georgia — but these markets represent some of the largest and fastest-growing healthcare regions in the country. This episode explains what CMS is testing, why these procedures were chosen, and how the results could shape future reimbursement and compliance expectations nationwide.

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