Understanding prior authorization (PA) for certain hospital outpatient department (OPD) services
The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA)...
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Botulinum toxin injections
Botulinum toxins are potent neuromuscular blocking agents that are useful in treating various focal muscle spastic disorders and...
Understanding repetitive scheduled non-emergent ambulance transports
Review these FAQs to learn more about the prior authorization for repetitive scheduled non-emergency ambulance transport.
Prior authorization program for certain hospital outpatient department services
CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or...
Prior authorization (PA) demonstration for certain ambulatory surgical center (ASC) services
CMS is implementing a five-year demonstration project for the PA of certain services provided in ASCs, for a limited number of...
Prior authorization program initiatives
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process...
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient
View these round results for rehabilitation services outpatient.
Targeted probe and educate (TPE) round results: End stage renal disease (ESRD) (CPT 90999)
Review the top denial / partial denial reasons and high-level results listed below from each round of JN ESRD TPE reviews.
Targeted probe and educate (TPE) round results: Wound debridement
View TPE round results for wound debridement (CPT 11102-11103, 11200-11201, 11300-11303, 11305-11313 and 11401-11406, 11421...