Outpatient Department Prior Authorization (PA)

Published 06/17/2021

The Centers for Medicare & Medicaid Services (CMS) has established a nationwide prior authorization (PA) process and requirements for certain hospital outpatient department (OPD) services. This process serves as a method for controlling unnecessary increases in the volume of these services and to ensure that medical necessity is met. 

  • Blepharoplasty
  • Botulinum toxin injections
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

Providers can submit a PA request as early as June 17, 2021, for date of service on or after July 1, 2021, for the following:

  • Cervical Fusion with Disc Removal
  • Implanted Spinal Neurostimulators

Please watch our website for upcoming education regarding OPD PA. You may go to the CMS website to view a full list of HCPCS codes that require a PA.

Resource: Jurisdiction J Part A Outpatient Prior Authorization Request Form (PDF, 158 KB).

Was this article helpful?