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 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
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 of the specific HCPCS codes that are included in the OPD PA program.