Providers Who Submit a Type of Bill 13X Are Required to Submit a Prior Authorization Request for the OPD PA Services
The National Government Services Medical Review Department initiated prior authorization reviews for the following outpatient department procedures: Panniculectomy, Rhinoplasty, Vein Ablation, Blepharoplasty and Botulinum Toxin.
Only hospital outpatient department services are require to obtain prior authorization as part of this program. Other facility/provider/supplier types such as physician’s offices, critical access hospitals, or ambulatory surgery centers that submit claims other than TOB 13X are not required to submit prior authorization requests.
Prior Authorization Reminder
The TOB is required to be submitted with the prior authorization request. Only providers who submit claims on TOB 13X are required to obtain prior authorization.