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ASC demonstration — official procedure references

ASC affirmation period: Affirmation and UTN last 120 days, with the decision date counted as day one; later service dates require a new request. Repeat procedures need their own request: Botulinum toxin injection and vein ablation require a new request for each procedure even within the 120-day window; this is not a clinical indication or code mapping. ASC exemption announcement is not eligibility: This FAQ describes a planned exemption process, not a grant of exemption to a provider. Require later official implementation evidence and provider confirmation before treating any provider as exempt. ASC facility UTN and related claims: The facility includes its UTN; related practitioners bill normally, but related services can be denied when the underlying facility service is not payable. ASC demonstration plan boundary: The demonstration applies to Medicare fee-for-service claims, not Medicare Advantage. Expedited review requires acceptance: Standard review is within seven days; expedited review is two business days only when the MAC accepts the request based on risk to life, health or regaining function. Requests can be converted to standard review. ASC non-affirmation and claim appeals: PA requests may be resubmitted without a numeric limit. PA non-affirmation itself is not appealable; a subsequently denied claim is an initial determination subject to appeal. Affirmation is not immunity from review: Targeted reviews for possible fraud or gaming and random CERT review can still occur after provisional affirmation. Source checked 2026-10-15. Documentary verification only; no clinical review or individual coverage determination.

Prior authorization: unknown. Member-specific applicability must be checked with the payer.
PayerCMS / Medicare
Plan contextOriginal Medicare — reference context only
ServiceASC demonstration
State scopeNot verified
Effective dateNot verified
RevisionSource b1f6b5b75411
Retrieved10/15/2026
EvidenceOpen original source ↗

Source evidence

Documentary checks establish what the official source says, not clinical eligibility.

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This public reference is available in full above. Paid research tools are not currently available; no clinical checklist or cross-payer authorization determination is included.

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Evidence fingerprint: b1f6b5b75411934779bd75248d1fbc68efa6913f5b69a85c87ada4024fce1de2