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This document was developed based on questions and answers posed during our webinars on the PA demonstration for ASC services.
View this updated listing of targeted probe and educate (TPE) review topics.
View these round results for rehabilitation services outpatient.
Summary for hyperbaric oxygen therapy (October 2020).
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 would remain in effect for a 12-month peri…
CMS has implemented the prior authorization program for certain repetitive, scheduled non-emergent ambulance transports in Florida, Puerto Rico and the US Virgin Islands. Learn more about the program and how you can participate.
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 subcutaneous tissue (including lipectomy),…
Nasal surgery is any procedure performed on the external or internal structures of the nose, septum or turbinate.
View targeted probe and educate (TPE) round results drugs and biologicals (HCPCS J1569).
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests for chemotherapy, drugs, biologicals, and injection services.