Prior Authorization - JF Part A
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Prior Authorization
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services - View outpatient department services that require prior authorization, the authorization process, how to submit a prior authorization request, the documentation requirements and coverage for the 8 services: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, vein ablation, spinal cord neurostimulator, cervical fusion and facet joint intervention for pain management.
Resources
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OPD Prior Authorization Coding
Blepharoplasty, Eyelid Surgery, Brow Lift, and related services
15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908
Botulinum Toxin Injection
64612, 64615
Procedure codes must be paired with the botulinum product HCPCS code: J0585, J0586, J0587, J0588
Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy), and related services
15830, 15847, 15877
Rhinoplasty and related services
20912, 21210, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30520
Vein Ablation and related services
36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483
Cervical Fusion with Disc Removal
22551, 22552
Implanted Spinal Neurostimulators
63650
Facet Injections
64490, 64491, 64493, 64494, 64633, 64634, 64635, 64636
Prior Authorization Lookup Tool
Determine which CPT/HCPCS codes require a Prior Authorization when performed in certain hospital OPD
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OPD Prior Authorization UTN Calculator
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