Prior Authorization Outpatient Department Self-Service Inquiry Tools
National Government Services continues to see PARs submitted for non-prior authorization HCPCS codes as well as requests submitted on behalf of providers on exemption.
NGS has developed two self-service inquiry tools that are available to both Part A and Part B providers who submit PARs on behalf of the HOPD.
Prior Authorization Reminders
- The prior authorization program for HOPD is only for specific HCPCS codes that are included in the program. If the procedure code is not found on the HCPCS Code Inquiry Tool, a prior authorization is not required.
- In addition, the OPD PA program is only for those procedures that will be completed in a HOPD setting. Other facility/provider types such as physician’s offices, critical access hospitals, or ambulatory surgery centers are not required to submit PARs at this time.
- Providers who qualified for exemption are not required to submit PARs for claims with dates of service on or after January 1. PARs should not be submitted for exempt providers for the purpose of obtaining a rejection letter for medical record keeping.
- OPD Operational Guide
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services Frequently Asked Questions (FAQs)