Outpatient Department Prior Authorization (PA)

The 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 to view a full list of HCPCS codes that require a PA.

Resource: Jurisdiction M Part A Outpatient Prior Authorization Request Form (PDF, 159 KB).

Outpatient Department Prior Authorization (PA) Articles