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Printed Date: 9/22/2015
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:
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.
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Last Updated: 05/14/2020
Applies to: Prior Authorization, JJ Part A, JJ Part B, JM Part A, JM Part B
Article Topics: Appeals, Redeterminations, and PTANs