{"id":4147,"date":"2020-06-25T17:37:26","date_gmt":"2020-06-25T17:37:26","guid":{"rendered":"https:\/\/www.saince.com\/?p=4147"},"modified":"2023-04-28T09:42:03","modified_gmt":"2023-04-28T13:42:03","slug":"hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services","status":"publish","type":"post","link":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/","title":{"rendered":"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services"},"content":{"rendered":"<p>For dates of service beginning July 1, 2020, you must request prior authorization for the following hospital Outpatient Department (OPD) services:<\/p>\n<ul>\n<li>Blepharoplasty<\/li>\n<li>Botulinum toxin injections (when paired with specific procedure codes)<\/li>\n<li>Panniculectomy<\/li>\n<li>Rhinoplasty<\/li>\n<li>Vein ablation<\/li>\n<\/ul>\n<p>Medical necessity documentation requirements remain the same and hospital OPDs will receive a decision within 10 days.<\/p>\n<p>While only the hospital OPD service requires prior authorization, CMS wants to remind other providers that perform services in the hospital OPD setting that claims related to\/associated with these services will not be paid if the service requiring prior authorization is not eligible for payment. These related services include, but are not limited to, anesthesiology services, physician services, and facility services. Only associated services performed in the hospital OPD setting are affected. Depending on the timing of claim submission for any related services, claims may be automatically denied, reviewed, or denied on a postpayment basis.<\/p>\n<p>For botulinum toxin injections, consult the list of codes that require prior authorization for more details. Generally, the use of botulinum toxin injection codes paired with procedure codes other than 64612 or 64615 will not require prior authorization under this program.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.cms.gov\/files\/document\/cpi-opps-pa-list-services.pdf\">List of codes that will require prior authorization (PDF)<\/a><\/li>\n<li><a href=\"https:\/\/www.cms.gov\/research-statistics-data-systems\/medicare-fee-service-compliance-programs\/prior-authorization-and-pre-claim-review-initiatives\/prior-authorization-certain-hospital-outpatient-department-opd-services\">Prior Authorization for Certain Hospital OPD Services<\/a><span>\u00a0<\/span>webpage<\/li>\n<li><a href=\"https:\/\/www.cms.gov\/files\/document\/opd-operational-guide.pdf\">Operational Guide (PDF)<\/a><\/li>\n<li><a href=\"https:\/\/www.cms.gov\/files\/document\/opd-frequently-asked-questions.pdf\">FAQs (PDF)<\/a><\/li>\n<li><a href=\"https:\/\/www.govinfo.gov\/content\/pkg\/FR-2019-11-12\/pdf\/2019-24138.pdf\">Final Rule<\/a>: Page 61446<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>For dates of service beginning July 1, 2020, you must request prior authorization for the following hospital Outpatient Department (OPD) services: Blepharoplasty Botulinum toxin injections (when paired with specific procedure codes) Panniculectomy Rhinoplasty Vein ablation Medical necessity documentation requirements remain the same and hospital OPDs will receive a decision within 10 days. While only the [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29,30,40],"tags":[],"class_list":["post-4147","post","type-post","status-publish","format-standard","hentry","category-clinical-documentation","category-clinical-documentation-improvement","category-outpatient-cdi"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.13 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services -<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services -\" \/>\n<meta property=\"og:description\" content=\"For dates of service beginning July 1, 2020, you must request prior authorization for the following hospital Outpatient Department (OPD) services: Blepharoplasty Botulinum toxin injections (when paired with specific procedure codes) Panniculectomy Rhinoplasty Vein ablation Medical necessity documentation requirements remain the same and hospital OPDs will receive a decision within 10 days. While only the [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/\" \/>\n<meta property=\"article:published_time\" content=\"2020-06-25T17:37:26+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-28T13:42:03+00:00\" \/>\n<meta name=\"author\" content=\"Raghu Vir\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Raghu Vir\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/\"},\"author\":{\"name\":\"Raghu Vir\",\"@id\":\"https:\/\/www.saince.com\/blog\/#\/schema\/person\/1f2d35babed92cc8da140a1e8098cc10\"},\"headline\":\"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services\",\"datePublished\":\"2020-06-25T17:37:26+00:00\",\"dateModified\":\"2023-04-28T13:42:03+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/\"},\"wordCount\":226,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.saince.com\/blog\/#organization\"},\"articleSection\":[\"Clinical Documentation\",\"Clinical Documentation Improvement\",\"Outpatient CDI\"],\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/\",\"url\":\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/\",\"name\":\"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services -\",\"isPartOf\":{\"@id\":\"https:\/\/www.saince.com\/blog\/#website\"},\"datePublished\":\"2020-06-25T17:37:26+00:00\",\"dateModified\":\"2023-04-28T13:42:03+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.saince.com\/blog\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.saince.com\/blog\/#website\",\"url\":\"https:\/\/www.saince.com\/blog\/\",\"name\":\"https:\/\/www.saince.com\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/www.saince.com\/blog\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.saince.com\/blog\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.saince.com\/blog\/#organization\",\"name\":\"Saince, Inc.\",\"url\":\"https:\/\/www.saince.com\/blog\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\/\/www.saince.com\/blog\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.saince.com\/blog\/wp-content\/uploads\/2022\/11\/logo.png\",\"contentUrl\":\"https:\/\/www.saince.com\/blog\/wp-content\/uploads\/2022\/11\/logo.png\",\"width\":177,\"height\":50,\"caption\":\"Saince, Inc.\"},\"image\":{\"@id\":\"https:\/\/www.saince.com\/blog\/#\/schema\/logo\/image\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.saince.com\/blog\/#\/schema\/person\/1f2d35babed92cc8da140a1e8098cc10\",\"name\":\"Raghu Vir\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\/\/www.saince.com\/blog\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/b86bb9fa0a2c418a075287e457916b047d92fa95e18ae97c28b6be424e9ba817?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/b86bb9fa0a2c418a075287e457916b047d92fa95e18ae97c28b6be424e9ba817?s=96&d=mm&r=g\",\"caption\":\"Raghu Vir\"},\"url\":\"https:\/\/www.saince.com\/blog\/author\/raghuvir\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services -","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/","og_locale":"en_GB","og_type":"article","og_title":"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services -","og_description":"For dates of service beginning July 1, 2020, you must request prior authorization for the following hospital Outpatient Department (OPD) services: Blepharoplasty Botulinum toxin injections (when paired with specific procedure codes) Panniculectomy Rhinoplasty Vein ablation Medical necessity documentation requirements remain the same and hospital OPDs will receive a decision within 10 days. While only the [&hellip;]","og_url":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/","article_published_time":"2020-06-25T17:37:26+00:00","article_modified_time":"2023-04-28T13:42:03+00:00","author":"Raghu Vir","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Raghu Vir","Estimated reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/#article","isPartOf":{"@id":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/"},"author":{"name":"Raghu Vir","@id":"https:\/\/www.saince.com\/blog\/#\/schema\/person\/1f2d35babed92cc8da140a1e8098cc10"},"headline":"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services","datePublished":"2020-06-25T17:37:26+00:00","dateModified":"2023-04-28T13:42:03+00:00","mainEntityOfPage":{"@id":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/"},"wordCount":226,"commentCount":0,"publisher":{"@id":"https:\/\/www.saince.com\/blog\/#organization"},"articleSection":["Clinical Documentation","Clinical Documentation Improvement","Outpatient CDI"],"inLanguage":"en-GB","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/","url":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/","name":"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services -","isPartOf":{"@id":"https:\/\/www.saince.com\/blog\/#website"},"datePublished":"2020-06-25T17:37:26+00:00","dateModified":"2023-04-28T13:42:03+00:00","breadcrumb":{"@id":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/#breadcrumb"},"inLanguage":"en-GB","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.saince.com\/blog\/hospital-outpatient-departments-effective-july-1-2020-you-must-request-prior-authorization-for-certain-hospital-outpatient-department-opd-services\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.saince.com\/blog\/"},{"@type":"ListItem","position":2,"name":"Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services"}]},{"@type":"WebSite","@id":"https:\/\/www.saince.com\/blog\/#website","url":"https:\/\/www.saince.com\/blog\/","name":"https:\/\/www.saince.com","description":"","publisher":{"@id":"https:\/\/www.saince.com\/blog\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.saince.com\/blog\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-GB"},{"@type":"Organization","@id":"https:\/\/www.saince.com\/blog\/#organization","name":"Saince, Inc.","url":"https:\/\/www.saince.com\/blog\/","logo":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/www.saince.com\/blog\/#\/schema\/logo\/image\/","url":"https:\/\/www.saince.com\/blog\/wp-content\/uploads\/2022\/11\/logo.png","contentUrl":"https:\/\/www.saince.com\/blog\/wp-content\/uploads\/2022\/11\/logo.png","width":177,"height":50,"caption":"Saince, Inc."},"image":{"@id":"https:\/\/www.saince.com\/blog\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/www.saince.com\/blog\/#\/schema\/person\/1f2d35babed92cc8da140a1e8098cc10","name":"Raghu Vir","image":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/www.saince.com\/blog\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/b86bb9fa0a2c418a075287e457916b047d92fa95e18ae97c28b6be424e9ba817?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b86bb9fa0a2c418a075287e457916b047d92fa95e18ae97c28b6be424e9ba817?s=96&d=mm&r=g","caption":"Raghu Vir"},"url":"https:\/\/www.saince.com\/blog\/author\/raghuvir\/"}]}},"_links":{"self":[{"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/posts\/4147","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/comments?post=4147"}],"version-history":[{"count":1,"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/posts\/4147\/revisions"}],"predecessor-version":[{"id":4755,"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/posts\/4147\/revisions\/4755"}],"wp:attachment":[{"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/media?parent=4147"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/categories?post=4147"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.saince.com\/blog\/wp-json\/wp\/v2\/tags?post=4147"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}