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 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
- Botulinum Toxin Injections
- Cervical Fusion with Disc Removal
- Implanted Spinal Neurostimulators
- Vein Ablation
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services (CMS)
- Federal Register
Last Updated Fri, 17 Sep 2021 17:14:18 +0000