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. 

  • 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

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.

Resources



Outpatient Department Prior Authorization (PA) Articles


Outpatient Hospital Department (OPD) Prior Authorization (PA) Fax NumberOutpatient Department (OPD) Prior Authorization (PA) Required DocumentationOutpatient Department (OPD) Prior Authorizations (PA)Outpatient Department Prior Authorization CalculatorOutpatient Department (OPD) Prior Authorization (PA) Alert!Prior Authorization Process for Certain Hospital Outpatient Department (OPD) Services Frequently Asked QuestionsPrior Authorization for Certain Hospital Outpatient Department (OPD) Services TerminologyOutpatient Department Prior Authorization (OPD) eServices Submission GuideBlepharoplasty and Blepharoptosis RepairOutpatient Department (OPD) Prior Authorization (PA) Part 1 Program OverviewOutpatient Department (OPD) Prior Authorization (PA) ExemptionThe Prior Authorization (PA) Program for Certain Hospital Outpatient Department (OPD) Services Operational GuideVein Ablation and Related ServicesesMD for the Review Choice Demonstration (RCD) and the Outpatient Department (OPD) Prior Authorization (PA)Botulinum Toxin InjectionsBotulinum Toxin InjectionsOutpatient Department (OPD) Prior Authorization (PA)PanniculectomyPanniculectomyOutpatient Prior Authorization (OPA) Status ToolSpinal Cord Stimulator ChecklistCervical Discectomy ChecklistCervical Disc Spinal Fusion and Spinal Cord Stimulator On-Demand WebcastVein Ablation and Related ServicesHospital Outpatient Department (OPD) Prior Authorization Exemption ProcessHow to Check Your Outpatient Department Prior Authorization (OPD) Results StatusRhinoplastyOPEN: Some Outpatient Department Prior Authorization Claims (OPA) are Editing for Reason Code 39621 IncorrectlyImplantation of Spinal Neurostimulator