Prior Authorization - JF Part A
Attend a Webinar
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.
Part A and B Prior Authorization Demonstration for Wasteful and Inappropriate Service Reduction (WISeR) Model - On January 15, 2026 in the states of Arizona and Washington, a CMS review demonstration program will begin. View the fourteen services with a streamlined review of medical necessity for select items and services, the authorization process and coverage requirements for each of the services.
Resources
OPD Prior Authorization Coding
64612, 64615
Procedure codes must be paired with the botulinum product HCPCS code: J0585, J0586, J0587, J0588
Prior Authorization Lookup Tool
Check if certain CPT or HCPCS codes need Prior Authorization before doing Part A outpatient, Part B ambulance, or ASC procedures.
Look at the coding list on the corresponding webpage to see what is needed for your facility and service.
Enter CPT/HCPCS Code:
OPD Prior Authorization UTN Calculator
Note: Enter dates as (mm/dd/yyyy)
