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Prior authorizations

Prior authorization program
CMS sponsors a variety of programs intended to safeguard beneficiary access to medically necessary items and services while reducing improper Medicare billing and payment. Prior authorization (PA) serves as a screening mechanism to help CMS ensure continued compliance with Medicare coverage requirements.
Under prior authorization, the provider or supplier submits the prior authorization request and supportive medical documentation to the MAC and receives an affirmed or non-affirmed decision prior to rendering the service. These initiatives do not change any medical necessity or documentation requirements.

Active initiatives
Effective March 18, 2022, CMS started the prior authorization for certain repetitive scheduled non-emergent ambulance transports for dates of service on or after April 1, 2022, in Florida, Puerto Rico and the U.S. Virgin Islands.
By submitting a completed cover sheet pdf file and the required documentation, a supplier can receive provisional prior authorization for as many as 40 round trips (80 one-way transports) in a 60-day period.
The PA program for RSNAT services includes the following HCPCS codes:
A0426 - Ambulance service, advanced life support, non-emergency transport, level 1 (ALS1)
A0428 - Ambulance service, basic life support (BLS), non-emergency transport
View ambulance RSNAT info
Overall, as a condition of payment, a prior authorization request (PAR) is required for the hospital OPD services listed below:
Blepharoplasty, blepharoptosis repair, and brow ptosis repair
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 PA program.
View HOPD info
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.
Electronic submission
Learn how to electronically submit your prior authorization requests, claims, and other correspondence.
Avoid the wait, submit electronically
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.