Prior authorization

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.

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.

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.

Nasal surgery is any procedure performed on the external or internal structures of the nose, septum or turbinate.

Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.

Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.

Hospital outpatient departments that qualify for an exempt status effective January 1, need to have at least 10 claims submitted and finalized.

Hospital outpatient departments that qualify for an exempt status effective January 1, need to have at least 10 claims submitted and finalized.

View these submission guidelines when submitting prior authorization requests for certain hospital outpatient department services.