Outpatient Department Prior Authorization (PA)

Published 11/01/2024

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. 

  • Blepharoplasty
  • Botulinum toxin injections
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

Providers can submit a PA request as early as June 17, 2021, for date of service on or after July 1, 2021, for the following:

  • Cervical Fusion with Disc Removal
  • Implanted Spinal Neurostimulators

Providers can submit a PA request as early as June 15, 2023, for date of service on or after July 1, 2023, for the following:

  • Facet Joint Interventions

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


Was this article helpful?

Palmetto GBA Web Chat

Sounds: OnSave Transcript
Please answer the questions below. Additional fields may appear based on previous answers. Fields with a red asterisk (*) are required.
Your InformationClear
1()-x
Inquiry InformationClear
Select your stateClear
Select your stateClear
Provider InformationClear
Patient InformationClear
Patient Name must exactly match the information submitted on the claim, including suffix if applicable.
//
Appeal InformationClear
//
//
Claim InformationClear
//
//
Denial InformationClear
//
//
Rejection InformationClear
DDE InformationClear
Restore InformationClear
//
Prior Authorization InformationClear
//
//
Application InformationClear
Product InformationClear
OtherClear
Additional InformationClear

Are you sure you want to end your chat?

Keep ChattingClose ChatSave Transcript & Close

Webchat

Our dedicated webchat representatives are online to assist you with your general inquiries, provider enrollment, EDI, eServices and more in real-time.