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

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.

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OPD Prior Authorization UTN Calculator


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