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View targeted probe and educate (TPE) round results for 15271-15278.
Blepharoplasty, blepharoptosis repair and brow lift are surgeries that may be performed to improve function or provided strictly for cosmetic reasons. Functional or reconstructive eyelid surgery is performed to improve abnormal function, re…
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.
Read this article to learn more about CERT reviews for vaccine and roster billed claims.
View TPE round results for drugs and biologicals (HCPCS J7318-J7329, J7331-J7332).
View these round results for rehabilitation services outpatient.
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 implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.
This article has been revised to include instructions for completing the PAR, the PAR review and decision process, guidance on multiple or staged procedures, as well as best practices, tips and reminders related to the PAR.
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process allows the provider to submit documentation prior to providing or billing the service. The contractor will then al…