Skip to Main Content

Print | Bookmark | Email | Font Size: + |

August 6, 2020

Prior Authorization for Certain Hospital Outpatient Department (OPD) Services: Part A Claims Only

CMS established a nationwide prior authorization process and requirements for certain hospital outpatient department (OPD) services. Effective for dates of service beginning July 1, 2020, prior authorization must be requested for specific CPT/HCPCS codes for five groups of hospital OPD services:

  • Blepharoplasty
  • Botulinum toxin injections
  • Panniculectomy
  • Rhinoplasty, and
  • Vein ablation

The specific CPT/HCPCS codes are listed hereExternal PDF.

Once the prior authorization is affirmed, a unique tracking number (UTN) is sent to the OPD.  When the service is billed, the UTN must be added to the OPD’s Part A claim.

NOTE:  Only the hospital OPD is required to include the UTN on claims, as the prior authorization process is only applicable to hospital OPD services. The Part B physician and other billing practitioners are NOT to submit the UTN.  Part B physician/practitioners should submit their claims as usual; however, claims related to/associated with services that require prior authorization as a condition of payment will not be paid, if the OPD service requiring prior authorization is not eligible for payment.

Resources:

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved