The Centers for Medicare and Medicaid Services (CMS) has announced it will move  ahead with a 5-year demonstration project requiring ambulatory surgery centers (ASCs) to receive prior authorization from Part B Medicare carriers for certain oculoplastic services. Beginning in December 2025, blepharoplasty, blepharoptis repair, brow ptosis repair, and botulinum toxin injection procedures must obtain prior authorization in 10 states: Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee, and Texas.

According to CMS, prior authorization helps ASC providers ensure their services meet Medicare coverage, coding, and payment rules before procedures are performed. The process does not add new documentation requirements, CMS noted; it requires information already needed to support payment to be submitted earlier to identify potential issues and reduce claim denials.

Michael Romansky, Washington, DC, counsel for the Outpatient Ophthalmic Surgery Society (OOSS), noted that the organization strenuously opposed this new program. The American Academy of Ophthalmology (AAO) and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) have also expressed opposition.
Mr. Romansky invited those with questions about the program to contact him at  mromansky@OOSS.org.