Prior Authorization - JF Part B

Part B Prior Authorization Programs

Prior Authorization Demonstration for Certain Ambulatory Surgical Center (ASC) Services in Arizona - On December 15, 2025 in the state of Arizona, a CMS prior authorization demonstration of certain ASC services will begin. View ASC services that require prior authorization, the authorization process, how to submit a prior authorization request, the documentation requirements and coverage for the 5 services: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation.

Prior Authorization for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Services - View Ambulance services that require prior authorization, the authorization process, how to submit a prior authorization request, the documentation requirements and coverage for the 2 services: A0426 - Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1); and A0428 - Ambulance service, basic life support, nonemergency transport (BLS).

Other Prior Authorization Programs

Part A Prior Authorization for Certain Hospital Outpatient Department (OPD) Services - This Program applies to Part A PTAN OPD billing only. Please navigate to Noridian Medicare Part A JF > Medical Review > Prior Authorization to view outpatient department services that require prior authorization, the authorization process, how to submit a prior authorization request, and 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.

For questions, please contact PartApriorauth@noridian.com

Starting December 15, 2025