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ACG

h.o.l.M.E.S.

Automated Clinical Guidelines

Cognitive WISeR Model Audit Tools

Indicates Non-covered Service

Beginning January 1, 2026, the prior authorization process under this model will be implemented in the selected states on the following items and services with affiliated NCDs or LCDs
 
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Prior Authorization: ASC Services Audit Tools

On December 15, 2025, CMS will start a 5-year prior authorization demonstration for certain services provided in ASCs in Ohio (Arizona, California, Florida, Georgia, Maryland, New York, Pennsylvania, Tennessee, and Texas).
Beginning on December 1, 2025, providers can submit prior authorization requests for dates of service on or after December 15, 2025.
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