MGMA Statement on Proposed Prior Authorization Model Impacting Medicare Part B (June 30, 2025)

FOR IMMEDIATE RELEASE:
June 30, 2025

Media Contact:
Samantha Tirado
Director of Policy Communications 
stirado@mgma.org 
 

MGMA Statement on Proposed Prior Authorization Model Impacting Medicare Part B

Anders Gilberg
Senior Vice President, Government Affairs
Medical Group Management Association

"While MGMA supports tackling waste, fraud, and abuse in Medicare Fee-for-Service, we are concerned about the Center for Medicare and Medicaid Innovation's (CMMI) announcement of the Wasteful and Inappropriate Service Reduction (WISeR) model, which will expand the use of prior authorization for certain services in six states under Medicare Part B. Prior authorization continually ranks as the number one administrative burden facing medical groups, and one of the hallmarks of traditional Medicare has been the ability for physicians, not government, to determine what’s clinically appropriate for their patients. At the beginning of last week, HHS and CMS announced an industry pledge from health plans to reduce the volume of medical services subject to prior authorization and additional measures meant to alleviate this significant burden. Through MGMA advocacy efforts, we've seen several CMS rules finalized to reduce prior authorization burden in Medicare Advantage and increase transparency. The announcement of this Part B model seems to contradict the administration's recent commitments to ease the burden of prior authorization. We look forward to working with CMMI and the administration on efforts to reduce waste and ensure they do not come at the cost of greater administrative burdens and interference with clinical decision-making."

###

About MGMA

Founded in 1926, the Medical Group Management Association (MGMA) is the nation's largest association focused on the business of medical practice management. MGMA consists of 15,000 group medical practices ranging from small private medical practices to large national health systems representing more than 350,000 physicians. MGMA helps nearly 60,000 medical practice leaders and the healthcare community solve the business challenges of running practices so that they can focus on providing outstanding patient care. Specifically, MGMA helps its members innovate and improve profitability and financial sustainability, and it provides the gold standard on industry benchmarks such as physician compensation. The association also advocates extensively on its members' behalf on national regulatory and policy issues.