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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.
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 phases.
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.
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.