Prior Authorization Strategies to Prevent Surgical Payment Delays

CMS policy changes and Medicare Advantage growth are expanding authorization requirements for ophthalmic surgery in the ASC setting.

By: Matthew Baugh, MHA, COT, OCS, OCSR

Ophthalmology Management May 1, 2026 Vol 30, Issue The Ophthalmic ASC May 2026 Page(s): 15-16

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CMS is expanding prior authorization (PA) requirements for ophthalmic surgeries in ambulatory surgery centers (ASCs) starting in 2026.
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Prior authorization has become routine in surgical reimbursement, affecting scheduling, documentation, and revenue-cycle workflows in ASCs.
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Accurate coding and documentation are crucial for obtaining PA approval, particularly for procedures like functional blepharoplasty.
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ASCs must ensure authorization is obtained before procedures, with clear communication between physician offices and ASC scheduling teams.
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Providers can qualify for PA exemptions by achieving a 90% provisional affirmation rate on PA requests during semiannual reviews.

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