Medical review

This article is designed to assist medical providers with documenting the beneficiary’s medical condition supporting coverage for non-emergent ambulance transportation.

Payment issue affecting end stage renal dialysis services on type of bill 72X.

View these submission guidelines for ASC prior authorization requests.

Prior authorization (PA) for the ASC prior authorization demonstration is voluntary. However, if a provider elects to bypass PA, applicable ASC claims will be subject to prepayment medical review.

The PAR fax/mail coversheet for ASCs is now available for Florida ASCs participating in the ASC PA demonstration. ASCs in Florida can submit PARs beginning on January 5, 2026, for dates of service (…

View targeted probe and educate (TPE) round results for nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127).

View targeted probe and educate (TPE) round results for nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127).

Effective for dates of service July 1, 2020, and after, hospital outpatient department (HOPD) providers will need to obtain prior authorization (PA) for panniculectomy, excision of excess skin and…

Effective for dates of service July 1, 2020, and after, hospital outpatient department (HOPD) providers will need to obtain prior authorization (PA) for panniculectomy, excision of excess skin and…

Vein ablation and related services; some patients may want varicose vein treatment for cosmetic reasons. Medicare does not cover cosmetic surgery or expenses incurred in connection with such surgery.