Outpatient Department Prior Authorization (PA)


The Centers for Medicare & Medicaid Services (CMS) has established a nationwide prior authorization (PA) process and requirements for certain hospital outpatient department (OPD) services. This process serves as a method for controlling unnecessary increases in the volume of these services and to ensure that medical necessity is met.

  • Blepharoplasty
  • Botulinum toxin injections
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

Providers can submit a PA request as early as June 17, 2021, for date of service on or after July 1, 2021, for the following:

  • Cervical Fusion with Disc Removal
  • Implanted Spinal Neurostimulators

Please watch our website for upcoming education regarding OPD PA. You may go to the CMS website to view a full list of HCPCS codes that require a PA.




Outpatient Department (OPD) Prior Authorization (PA) Alert!Outpatient Department (OPD) Prior Authorization (PA) Required DocumentationPrior Authorization Process for Certain Hospital Outpatient Department (OPD) Services Frequently Asked QuestionsOutpatient Department (OPD) Prior Authorizations (PA)Outpatient Department Prior Authorization CalculatorOutpatient Hospital Department (OPD) Prior Authorization (PA) Fax NumberOutpatient Department Prior Authorization (OPD) eServices Submission GuideBlepharoplasty and Blepharoptosis RepairPrior Authorization for Certain Hospital Outpatient Department (OPD) Services TerminologyOutpatient Department (OPD) Prior Authorization (PA) Part 1 Program OverviewThe Prior Authorization (PA) Program for Certain Hospital Outpatient Department (OPD) Services Operational GuideesMD for the Review Choice Demonstration (RCD) and the Outpatient Department (OPD) Prior Authorization (PA)Botulinum Toxin InjectionsOutpatient Department (OPD) Prior Authorization (PA)ADRs for Outpatient Department Prior Authorization services (OPD PA) ServicesPanniculectomyCervical Disc Spinal Fusion and Spinal Cord Stimulator On-Demand WebcastVein Ablation and Related ServicesHospital Outpatient Department (OPD) Prior Authorization Exemption ProcessRhinoplastyVein Ablation and Related Services ChecklistCervical Fusion with Disc RemovalHospital Outpatient Department (OPD) Prior Authorization Exemption ProcessPanniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy), and Related ServicesOutpatient Department Prior Authorization ExemptionMedicare Exemption: Prior Authorization of Certain Hospital Outpatient Services Video

Last Updated: 06/17/2021