CMS implemented a
prior authorization program for certain hospital outpatient department (OPD) services, effective June 17, 2020, for dates of service (DOS) on or after July 1, 2020. 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.
As a condition of payment for DOS on or after July 1, 2020, 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
CMS has added two new services to the hospital OPD PA program. As a condition of payment for DOS beginning on or after July 1, 2021, a PAR is required for these two additional hospital OPD services:
Cervical fusion with disc removal
• Implanted spinal neurostimulators
CMS provides a list
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
First Coast Service Options, Inc.
JN Prior Authorization
PO Box 3033
Mechanicsburg, PA 17055-1804
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.