Prior Authorization for Certain Hospital Outpatient Department (OPD) Services - JE Part A
Medical Review
- Documentation Requests: How, Who and When to Send
- Documentation Requirements
- How Do I Check DDE for an ADR?
- How Do I Respond to an ADR?
- MR FAQs
- MR Overview
- MR Reopening
- Medical Documentation Signature Requirements
- Medical Record Review Results
- Order Authentication Requirements
- Prior Authorization
- Post-Pay Reviews
- Pre-payment Review
- Targeted Probe and Educate (TPE)
- Who Reviewed My Claim
- Why Is My Claim Denied
- Other Review Contractors
Tell us what you think
Your comments will help us improve our services.
Take the Prior Authorization Survey
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 cover hospital Outpatient Department Services (OPD). Effective for dates of service July 1, 2020, and after, providers must request prior authorization for the following hospital OPD services: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation. Effective for dates of service July 1, 2021, cervical fusion with disc removal and implanted spinal neurostimulators.
The hospital OPD provider will submit the PA to their Medicare Administrative Contractor (MAC) jurisdiction. The term requestor will be used throughout this page to describe the person or entity that submits the prior authorization request (PAR), documentation, and/or claims. The MAC will review information submitted and issue the decision (affirmative or non-affirmative) to the provider.
The provider may resubmit a PAR with additional supporting information, upon receipt of a non-affirmation, as many times as necessary to achieve an affirmation decision.
For questions, please contact PartApriorauth@noridian.com
- Authorization Process
- Submitting a Prior Authorization Request
- Provider Exemptions
- Blepharoplasty
- Botulinum Toxin Injections
- Cervical Fusion with Disc Removal
- Facet Joint Interventions for Pain Management
- Implanted Spinal Neurostimulators
- Panniculectomy
- Rhinoplasty
- Vein Ablation
Resources
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services (CMS)
- Federal Register
Last Updated Wed, 03 May 2023 17:51:56 +0000