Prior Authorization and Pre-Claim Review Initiatives | CMS CMS runs a variety of programs that support efforts to safeguard beneficiaries’ access to medically necessary items and services while reducing improper Medicare billing and payments Through prior authorization and pre-claim review initiatives, CMS helps ensure compliance with Medicare rules
New Medicare Changes in 2026: Prior Approval Required for These 17 Services Beginning January 1, 2026, Traditional Medicare will require prior authorization for 17 medical procedures in six pilot states Learn which services and states are affected, how the WISeR program works, and what this means for patients and providers
Does Medicare Require Prior Authorization? | U. S. News Learn about when and why prior authorizations are needed, which services require them and how they are used differently between original Medicare and Medicare Advantage
Medicare Prior Authorization - Center for Medicare Advocacy Originally, the Social Security Act did not authorize any form of Prior Authorization for Medicare services, but the law was subsequently changed to allow Prior Authorization for limited items of Durable Medical Equipment and, more recently, certain hospital outpatient department services
How Common Is Medicare Prior Authorization Required? - AARP In 2024, the Centers for Medicare Medicaid Services (CMS) started to require Medicare Advantage plans to streamline their prior authorization process to ensure people with Medicare Advantage receive access to the same medically necessary care they would receive in original Medicare
Medicare prior authorization 2026 - Medicare Planning Starting in 2026, both Traditional Medicare and Medicare Advantage plans will operate under updated prior authorization rules These changes are designed to increase transparency, speed up decisions, and test new methods for reducing unnecessary services