Prior Authorization for Certain Hospital Outpatient Department (OPD) Services - JE Part A
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
The Federal Register established a prior authorization (PA) process as a condition of payment for certain covered hospital Outpatient Department Services (OPD).
This program is only for facilities billing using a valid Part A facility PTAN on a Type of Bill 13X.
Hospital Outpatient Department (OPD) Services that Require Prior Authorization
- Blepharoplasty
- Botulinum Toxin Injections
- Cervical Fusion with Disc Removal
- Facet Joint Interventions for Pain Management
- Implanted Spinal Neurostimulators
- Panniculectomy
- Rhinoplasty
- Vein Ablation
What needs to go through this program:
- Certain procedures specified by CMS that take place in an Outpatient Hospital setting and are billed by Part A. Services are allowed based on medical necessity.
What does NOT need to go through this program:
- Prescription drugs- Contact beneficiary’s Part D insurance for further assistance.
- Repetitive Scheduled Non-Emergent Ambulance transport (RSNAT)- RSNAT is a Part B service
- Oxygen or home medical equipment- These requests are DME requests
- Radiology tests (MRIs, CTs, X-Rays)- There is currently no division within Noridian that does prior authorization for radiology testing.
Authorization Process Overview
- Authorization Process
- Submitting a Prior Authorization Request
- Common Part A OPD Prior Authorization Request Questions and Answers
- Clinician’s Checklist
Authorization Exemption Program
- Provider Exemptions
- How to Respond to a OPD Prior Authorization ADR
- Part A OPD Prior Authorization Exemption Process Questions and Answers
Contact Us
For questions, please contact PartApriorauth@noridian.com. Be sure to include the Beneficiary's MBI, PTAN, CPT/HCPCS code(s), UTN (unique tracking number), and the issue you are experiencing.
Fax: 701-277-2903. Attn: Part A Prior Authorization
Resources
Last Updated May 16 , 2025
