2025 PRIOR AUTHORIZATION METRICS

To comply with the CMS Interoperability and Prior Authorization final rule New York State Medicaid is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical and dental items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs and payers.

Reporting Period: 2025

• Medical items and services (excluding drugs) that require prior authorization during 2025
• Prior Authorization Metrics