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Prior authorizations

Prior authorization program for certain hospital outpatient department services
CMS implemented a nationwide prior authorization program in July 2020 for certain hospital outpatient department (OPD) services, with additional services added in July 2021. CMS believes prior authorization for certain hospital OPD services will ensure that Medicare beneficiaries continue to receive medically necessary care while protecting the Medicare Trust Fund from improper payments and keeping the medical necessity documentation requirements unchanged for providers.
Overall, as a condition of payment, a prior authorization request (PAR) is required for the following hospital OPD services:
Blepharoplasty, eyelid surgery, brow lift, and related services
Botulinum toxin injections
Panniculectomy, excision of excess skin and subcutaneous tissue (including lipectomy), and related services
Rhinoplasty and related services
Vein ablation and related services
Cervical fusion with disc removal
Implanted spinal neurostimulators
CMS provides a list external pdf file of the specific HCPCS codes that are included in the OPD prior authorization program.
PA contact information
Prior authorization customer service phone number: 855-340-5975
Fax number: 855-815-3065
Mailing address:
First Coast Service Options, Inc.
JN Prior Authorization
PO Box 3033
Mechanicsburg, PA 17055-1804
Link to more
Additional resources
View additional information regarding overall prior authorization initiatives.
Submit your PAR electronically
Save time, submit online.
SPOT users can upload and submit their OPD PARs through the secure documentation functionality on SPOT. Not a SPOT user? Learn more and register today.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.