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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

 

Updated: 09.25.2025

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