As of January of 2026, Original Medicare in Arizona has introduced a prior authorization (PA) requirement for certain services, aimed at ensuring that treatments are medically necessary and covered. This process may impact on how beneficiaries access care, so it’s essential to be informed about which procedures may require prior approval.

What is Prior Authorization?

Prior authorization is a process where healthcare providers must obtain approval from Medicare before performing specific services or procedures. This helps to streamline care and ensure that patients receive only necessary treatments.

Affected Outpatient Procedures

Below are some examples of outpatient procedures that may require prior authorization under Original Medicare:

**Surgical Procedures**:

- Arthroscopic surgeries (e.g., knee or shoulder surgery)

- Gastrointestinal procedures (e.g., certain types of colonoscopies)

**Endoscopic Procedures**:

- Upper endoscopy (EGD)

- Bronchoscopy

**Cardiac Procedures**:

- Certain catheterizations or stent placements

- Electrophysiology studies

**Pain Management Procedures**:

- Epidural steroid injections

- Nerve blocks

**Imaging Procedures**:

- High-level imaging studies (e.g., MRI or CT scans) that are not part of standard diagnostic protocols

**Certain Diagnostic Tests**:

- Genetic testing with specific criteria

- Advanced lab tests not considered routine

What This Means for YOU!

**Consult Your Provider**: It's vital to discuss any upcoming procedures with your healthcare provider to determine if prior authorization is needed.

**Plan Ahead**: Ensure that any necessary authorizations are obtained in advance to avoid delays in receiving care.

By understanding the prior authorization process and its implications, Original Medicare beneficiaries in Arizona can better navigate their healthcare options and ensure timely access to necessary services.

If you have any questions or need further information, feel free to reach out to me!

Nadia Jackson