2 prior authorization updates for spine surgeons

Spine

Spine surgeons have been advocating for legislation to improve prior authorization processes. Here are two developments from this year to know:

In January CMS finalized a rule to improve the prior authorization process. It will go into effect in 2026 and will require some payers to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests. Affected payers will also have to include specific reasons for denying a prior authorization and publicly report prior authorization metrics. 

In June spine surgeons advocated a bill that would streamline prior authorizations for Medicare Advantage patients. The "Improving Seniors' Timely Access to Care Act" would establish an electronic prior authorization process for Medicare Advantage plans, increase transparency around prior authorizations and give a pathway for CMS to institute real-time decisions for routinely approved services. The bill, with 42 original co-sponsors, will also clarify CMS' authority to establish timelines for electronic prior authorization requests and require reports on program integrity efforts. 

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