Free Medicare prior-authorization check
See what the reviewer will judge your prior authorization against, before you submit.
WISeR reviewers, the hospital outpatient program and Medicare Advantage plans must apply Medicare’s coverage policy. Enter the procedure, diagnosis and state to see the policy in force, its requirements word for word, and whether your diagnosis is on its list.
No account. No credit card. No patient data.
- Quoted from the policy in force, with the CMS link
- WISeR, hospital outpatient, ASC and Medicare Advantage
- Exemption tracker for WISeR and outpatient requests
- CMS’s own WISeR documentation checklist for the service
Trigger Point Injections
- Effective
- 2026-09-06
- Contractor
- First Coast
- Codes held
- 3 HCPCS (showing J0585)
We hold this policy, the codes it governs, and the date CMS published it — and every one of those is checkable against the document itself.
Free authorization check
Does Medicare require authorization for this procedure — and what does the policy require?
The program, the decision clock and route, the governing policy as it stands today, whether the diagnosis is on its list, the documentation its own text requires and, where WISeR applies, CMS’s own documentation checklist for the service — quoted, never summarised. It never predicts a decision.
Already denied? Run the denial check — the governing policy and the date its version took effect.
Not legal, billing, or coding advice. The linked CMS documents are authoritative; this check only reports what they list.
How we work
We supply the evidence. You file.
Two ways to work with us — neither ever touches patient data.
For practices that file prior-authorization requests
01
Check before you request.
Procedure, diagnosis, state and setting. See which Medicare program requires authorization, the governing policy as it stands today, the documentation its own text requires and, under WISeR, CMS's own checklist for the service.
02
Log each request by your own label.
Straight from the check result, or by CSV. Never the NPI, never the patient. The tracker counts each provider's requests toward the exemption the participant grants, and a weekly email shows where each provider stands.
03
After a non-affirmation, resubmit with the policy.
A packet quotes the governing policy verbatim and states what the record must show, beside CMS's WISeR checklist where WISeR applies — or is refused, with the reason, when a coverage packet does not answer it.
$99 a month per practice. Cancel any time.
For billing and revenue-cycle companies
You send the denials; we return a grounded packet for each one we can support and a clear refusal for each one we cannot. You file under your own name. Nothing is charged for a refusal.
01
Send the denial, not the chart.
A procedure code, a diagnosis code and the state. No dates and nothing about the patient ever reaches us — the check refuses anything that looks like an identifier.
02
We find the policy that bound the plan on that date.
A Medicare Advantage plan must follow CMS's national coverage determinations and the local contractor's written coverage decisions. We hold those as dated text and cite the version in force — not today's page.
03
If we cannot ground it, we say so and stop.
No policy on file, or the diagnosis is not on the policy's covered list, means no packet. The refusal is the product working, not failing.
What we hold
Public documents, held the way an appeal needs them.
National and local coverage determinations, their billing articles and diagnosis lists, and the Medicare Advantage benefit filings that show which plans changed prior authorization and when — captured as dated text, so the version in force on any date can be cited.
- 2,100+
- Policy records held
- 16
- MAC jurisdictions
- 33
- Clinical specialties
- 9
- Government sources
The policy corpus
Every coverage policy we hold, by contractor, with its effective date, the versions captured and its CMS link. Never behind a login.
Browse the corpus →The Change Ledger
Which Medicare Advantage plans added or removed prior authorization, plan year over plan year, as reported to CMS.
See the ledger →The archive, live
When each source last updated and how many policy versions are held — a cadence you can watch, not a claim.
Check archive status →How each record is captured, dated and verified is written down: Methodology · Data sources.
Start with the check. Then choose your path.
Practices start the plan in two minutes. Billing companies send a denial file — five columns, nothing about the patient — and get back, per denial, a grounded packet or an honest refusal.
Not legal, billing, or coding advice. The linked CMS documents are authoritative; this check only reports what they list.