Prior authorization

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Hospital outpatient department (OPD) prior authorization exemption process

Hospital outpatient departments (OPDs) who demonstrate compliance with Medicare coverage, coding, and payment rules related to prior authorization (PA) may be eligible for exemption. This exemption…

Hospital outpatient department (OPD) prior authorization exemption process

Hospital outpatient departments (OPDs) who demonstrate compliance with Medicare coverage, coding, and payment rules related to prior authorization (PA) may be eligible for exemption. This exemption…

Ambulance Prior Authorization Documentation Requirements

Review this checklist to learn about the documentation requirements to ensure an affirmed decision on your prior authorization request (PAR) for repetitive, scheduled, non-emergency transport.

Prior authorization (PA) demonstration for certain ambulatory surgical center (ASC) services

CMS is implementing a five-year demonstration project for the prior authorization of certain services provided in Ambulatory Surgical Centers (ASCs) and will be implementing the demonstration in two…

Prior authorization program for certain hospital outpatient department services

CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.

Botulinum toxin injections

Botulinum toxins are potent neuromuscular blocking agents that are useful in treating various focal muscle spastic disorders and excessive muscle contractions, such as dystonia, spasms, and twitches.

Prior authorization program for certain hospital outpatient department services

CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.

Vein ablation and related services

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.

Botulinum toxin injections

Botulinum toxins are potent neuromuscular blocking agents that are useful in treating various focal muscle spastic disorders and excessive muscle contractions, such as dystonia, spasms, and twitches.

Vein ablation and related services

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.