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Outpatient Department (OPD) Prior Authorization Calculator

A provisional affirmation prior authorization (PA) decision is a preliminary finding that a future claim submitted to Medicare for the service(s) likely meets Medicare's coverage, coding and payment requirements. The provisional affirmation PA decision is valid for 120 days from the date of the decision.

The Outpatient Department Prior Authorization Calculator will provide the end of the 120 day timeframe, in which the approved procedure should be performed before the authorization expires.

To determine the date the authorization expires, key the date of the Prior Authorization Affirmation and click Calculate.

Enter the date of the PA Decision:

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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