AAPM&R has urged the Centers for Medicare & Medicaid Services (CMS) not to finalize a proposal that would expand hospital outpatient prior authorization requirements to include additional botulinum toxin injection services. In comments on the CY 2027 Outpatient Prospective Payment System proposed rule, AAPM&R emphasized that increased use of these treatments reflects improved access to care for patients with spasticity and other neurologic conditions, not evidence of widespread fraud or abuse. The Academy warned that additional prior authorization requirements would create significant administrative burdens for physiatrists and could delay medically necessary treatment for vulnerable patients.
AAPM&R also encouraged CMS to use more targeted program integrity tools instead of broad prior authorization mandates and highlighted the need to reduce unnecessary regulatory burden so physicians can spend more time caring for patients. Academy members also voiced concerns on this issue, with 83 physiatrists submitting comments to CMS opposing the prior authorization proposal through our Advocacy Action Center. Thank you for your advocacy!
The Academy’s comments to CMS also expressed support for CMS's efforts to establish reimbursement pathways for emerging AI-enabled and software-based clinical technologies, helping ensure PM&R physicians can benefit from innovations that improve patient care. Members with questions can contact the Academy at healthpolicy@aapmr.org.