Wiki Medicare Prior Auth required for certain services performed at a hospital outpatient department

[sxcoder]

Hello! Hoping someone can help clarify. Medicare is now requiring prior authorization for certain services that are performed at a hospital outpatient department that started July of last year. Since this is process fairly new I am assuming prior auth is not needed for inpatient surgeries? Thank you in advance.

• Cervical Fusion with Disc Removal * added for DOS 7/1/21
• Implanted Spinal Neurostimulators * added for DOS 7/1/21
• Blepharoplasty
• Botulinum Toxin Injections
• Panniculectomy
• Rhinoplasty
• Vein Ablation

 

[rosbole]

That's correct. It is required for hospital outpatient departments that bill on a 13X type of bill.

 

[bhargavi]

question: is this pulmonary vein ablation- cpt 93656 needs outpt prior auth from medicare? just want to make sure. we are going to start this outpt procedure

 

[rosbole]

https://www.cms.gov/files/document/opd-services-require-prior-authorization.pdf This is the list of outpatient procedures that require prior auth as of 7/1/2021.