Outpatient Department PA

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. Providers can submit a PA request as early as June 17, 2020, for date of service on or after July 1, 2020, for the following:

1.Blepharoplasty
2.Botulinum toxin injections
3.Panniculectomy
4.Rhinoplasty
5.Vein ablation

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

Resources:

 


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Provider Contact Center: 855-696-0705

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