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.

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Latest Articles

      

ADRs for Outpatient Department Prior Authorization services (OPD PA) Services 04/01/2021
esMD for the Review Choice Demonstration (RCD) and the Outpatient Department (OPD) Prior Authorization (PA) 03/19/2021
Outpatient Department (OPD) Prior Authorization (PA) 03/11/2021
Outpatient Department (OPD) Prior Authorization (PA) Exemption 02/25/2021
Outpatient Prior Authorization (OPA) Status Tool 08/04/2020
Outpatient Hospital Department (OPD) Prior Authorization (PA) Fax Number 07/02/2020
Outpatient Department (OPD) Prior Authorization (PA) Required Documentation 06/25/2020
Outpatient Department Prior Authorization Calculator 06/22/2020
Outpatient Department (OPD) Prior Authorization (PA) Part 1 Program Overview Open in New Window06/22/2020
Outpatient Department (OPD) Prior Authorization (PA) Part 2 Medical Necessity Open in New Window06/22/2020
Botulinum Toxin Injections 06/16/2020
Outpatient Department Prior Authorization (OPD) eServices Submission Guide 06/03/2020
Prior Authorization Process for Certain Hospital Outpatient Department (OPD) Services Frequently Asked Questions Open in New Window05/27/2020
The Prior Authorization (PA) Program for Certain Hospital Outpatient Department (OPD) Services Operational Guide Open in New Window05/27/2020
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services Terminology 05/22/2020
Blepharoplasty and Blepharoptosis Repair 05/14/2020
Outpatient Department (OPD) Prior Authorizations (PA) 05/14/2020
Panniculectomy 05/14/2020
Rhinoplasty 05/14/2020
Vein Ablation and Related Services 05/14/2020
   

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