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Prior Authorization: Hospital OPD Services

CMS established a nationwide prior authorization process as a condition of payment for certain hospital outpatient department (OPD) services. This means Part A hospital OPDs must submit a prior authorization request and supporting documentation to their Medicare Administrative Contractor (MAC) and receive a decision before rendering the service and submitting a claim.

PA

Prior Auth Process

Exemption

Provider Exemption Process

Forms

Prior Auth Forms & Resources

Blepharolplasty

Blepharoplasty

Injections

Botulinum Toxin Injections

Spine

Cervical Fusion with Disc Removal

Spine

Facet Joints

Spinal Neurostimulators

Implanted Spinal Neurostimulators

Panniculectomy

Panniculectomy

Rhinoplasty

Rhinoplasty

Vein Ablation

Vein Ablation

 

Last Reviewed: 07.17.2026

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