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Prior Authorization

Hospital Outpatient Department Prior Authorization

The Centers for Medicare & Medicaid Services (CMS) established a nationwide prior authorization (PA) process as a condition of payment for certain hospital outpatient department (OPD) services. Effective for dates of service July 1, 2020, Part A hospital OPDs must submit a prior authorization request (PAR) and supporting documentation to their Medicare Administrative Contractor (MAC) and receive a decision before rendering the service and submitting a claim for processing.

PA Exemption Forms Blepharolplasty Injections

Prior Auth Process

Provider Exemption Process

Prior Auth Resources/Forms


Botulinum Toxin Injections

Spine Spine Spinal Neurostimulators Panniculectomy Rhinoplasty

Cervical Fusion with Disc Removal

Facet Joints

Implanted Spinal Neurostimulators



Vein Ablation        

Vein Ablation



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