Outpatient Department Prior Authorization (PA)

Published 07/07/2026

The Centers for Medicare & Medicaid Services (CMS) has established a nationwide prior authorization (PA) process and requirements for certain hospital outpatient department (OPD) services. This process serves as a method for controlling unnecessary increases in the volume of these services and to ensure that medical necessity is met. 

  • Blepharoplasty
  • Botulinum toxin injections
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

Providers can submit a PA request as early as June 17, 2021, for date of service on or after July 1, 2021, for the following:

  • Cervical Fusion with Disc Removal
  • Implanted Spinal Neurostimulators

Providers can submit a PA request as early as June 15, 2023, for date of service on or after July 1, 2023, for Facet Joint Interventions.

Please watch our website for upcoming education regarding OPD PA. You may go to the CMS website to view a full list of HCPCS codes that require a PA.

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