MASH or NASH (liver)
What the FAA's documents say about MASH or NASH (liver), in plain words, with the FAA's own words one press away.
FAA term: MASH/NASH (Liver)
- The worksheet lists a weight loss medication among the medications for the condition and says to see that page, without naming it. Crosscheck has a page on weight loss management, written from the FAA's weight loss management documents.
Your step-by-step plan
Step 1: The progress note from the hepatologist or treating physician
The note the examiner reviews, and what it verifies.Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
It verifies
- The condition is under control
- Insulin resistance, if present, is adequately treated
- No symptoms (such as fatigue or malaise) that would interfere with flight or safety related duties
Show the FAA's words: The progress note from the hepatologist or treating physician
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – MASH / NASH (Liver). FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
A current, detailed Clinical Progress Note from the Hepatologist or treating physician verifies: [ ] Condition is under control, insulin resistance (if present) is adequately treated, and no symptoms (such as fatigue or malaise) that would interfere with flight or safety related duties.
FAA source: CACI – MASH / NASH (Liver). FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Step 2: The worksheet's criteria
A fibrosis score, cirrhosis, and your medications for the condition.Fibrosis score from lab or imaging
A fibrosis score from lab or imaging performed no more than 90 days ago, with none of the values exceeded.
The worksheet's values
- FIB-4 index less than 2.68
- Ultrasound-based vibration-controlled transient elastography (VCTE) less than 8 kPa
- Magnetic resonance elastography less than 2.55 kPa
If an imaging study has not been performed, the FIB-4 index is calculated, which requires age, platelet count, AST and ALT.
Your medications for the condition
Any combination of none, vitamin E, and a weight loss medication.
The worksheet's other criteria
- No clinical evidence or diagnosis of cirrhosis
Show the FAA's words: The worksheet's criteria
Fibrosis score from lab or imaging performed no more than 90 day ago
None of the values are exceeded:
[ ] FIB-4 index* is less than 2.68; or [ ] Ultrasound-based vibration-controlled transient elastography (VCTE) is less than 8 kPa; or [ ] Magnetic resonance elastography is less than 2.55 kPa
*If an imaging study has not been performed, calculate the FIB-4 index (requires age, platelet count, AST, and ALT).
FAA source: CACI – MASH / NASH (Liver). FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Medications for condition (any combination of): [ ] None [ ] Vitamin E [ ] Weight loss medication (see that page)
FAA source: CACI – MASH / NASH (Liver). FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Any clinical evidence or diagnosis of cirrhosis: [ ] None
FAA source: CACI – MASH / NASH (Liver). FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
If the examiner defersFAA review
When the pilot is not CACI qualified, the worksheet has the examiner note in Block 60 that they have deferred, and submit supporting documents.
What the FAA lists to send
- Item 1. Supporting documents, which the worksheet's note for a pilot who is not CACI qualified has the examiner submit.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
When the pilot is not CACI qualified, the worksheet has the examiner note in Block 60 that they have deferred, and submit supporting documents.
AME MUST NOTE one of the following in Block 60: … NOT CACI qualified MASH/NASH. I have deferred. (Submit supporting documents.)
What the FAA lists to send
- Item 1
Supporting documents, which the worksheet's note for a pilot who is not CACI qualified has the examiner submit.
NOT CACI qualified MASH/NASH. I have deferred. (Submit supporting documents.)
At later exams
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Two 90-day limits
The worksheet's progress note is from a clinic visit with the treating physician or specialist no more than 90 days before the exam. The fibrosis score is from lab or imaging performed no more than 90 days ago.
Show the FAA's words: good to know, 2
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. … Fibrosis score from lab or imaging performed no more than 90 day ago
FIB-4 when there is no imaging
If no imaging study has been performed, the worksheet says the FIB-4 index is calculated, which needs age, platelet count, AST and ALT.
Show the FAA's words: good to know, 3
*If an imaging study has not been performed, calculate the FIB-4 index (requires age, platelet count, AST, and ALT).
Three statements for Block 60
The worksheet has the examiner note one of three statements in Block 60: CACI qualified (no documents go to the FAA); a current or previous SI/AASI but now CACI qualified; or not CACI qualified, deferred, with supporting documents submitted.
Show the FAA's words: good to know, 4
AME MUST NOTE one of the following in Block 60: … CACI qualified MASH/NASH. (Documents do not need to be submitted to the FAA.) … Has current OR previous SI/AASI but now CACI qualified MASH/NASH. … NOT CACI qualified MASH/NASH. I have deferred. (Submit supporting documents.)
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
Medication guidance
Medications Crosscheck lists as taken for MASH or NASH (liver), each with its own page on what published FAA guidance says about it.
- Medication for the condition on the FAA's MASH/NASH (liver) worksheet
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.