Traditional Medicare, also known as original Medicare, has historically required little in the way of pre-authorization for beneficiaries seeking services; pre-authorization was typically the domain of Medicare Advantage. But that has changed, as the Centers for Medicare and Medicaid Services (CMS) has implemented prior authorization requirements for certain traditional fee-for-service Medicare services in six states.
This change went into effect on January 1, 2026, as CMS starts to "test ways to provide an improved and expedited prior authorization process relative to original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars," per a CMS press release. The model being implemented in 2026 builds on a change to prior authorizations rolled out by the Department of Health and Human Services (HHS) and CMS on June 23, 2025.
