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OPD Prior Authorization

OPD Prior Authorization

The Centers for Medicare & Medicaid Services (CMS) established a nationwide prior authorization process and requirements for certain hospital outpatient department (OPD) services. Effective for dates of service beginning July 1, 2020, prior authorization must be requested for the outpatient department services listed below under Tools and Resources. Medical necessity documentation requirements remain the same. For additional information, refer to the Hospital Outpatient Prospective Payment System Final RuleExternal PDF and the Prior Authorization for Certain Hospital Outpatient Department (OPD) ServicesExternal Website information on the CMS website.

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