Do I need to obtain prior authorization or precertification before I provide a Part B service to a Railroad Medicare patient?

Answer:
Prior authorization or precertification is not required for any Part B services billed to Palmetto GBA Railroad Medicare at this time. As the Centers for Medicare & Medicaid Services (CMS) continues to expand its preauthorization and prior authorization programs, it’s important that you visit our website regularly for updates to this policy.

Prior authorization may be required for Part B services provided to Railroad Medicare patients when the claim for the service will be billed to and processed by another Medicare Administrative Contractor. Part B claims for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) that are under DME MAC jurisdiction are billed to your local DME MAC for Medicare and Railroad Medicare patients.  Part B outpatient facility claims that you bill on UB-04 CMS-1450 forms or equivalent electronic claim forms are billed to your jurisdictional A/B MAC for Medicare and Railroad Medicare patients. Part B claims for Railroad Medicare patients that are submitted to a DME MAC or jurisdictional A/B MAC are subject to any prior authorization or precertification requirements that apply to the services you are billing to that MAC.  

Contact Railroad Medicare

Email Railroad Medicare

Contact a specific Railroad Medicare department

Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

Other Palmetto GBA Sites

Palmetto GBA Home

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Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

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PDAC

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RRB Specialty MAC Beneficiaries

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