Outpatient Department (OPD) Prior Authorizations (PA)

Published 05/14/2020

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 ensures 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

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