May 25, 2020

CMS Releases HCPCS Codes for Certain Outpatient Services Requiring Prior Authorization

The Centers for Medicare and Medicaid Services (CMS) released the list of hospital outpatient department services and the Healthcare Common Procedure Coding System (HCPCS) billing codes that will require prior authorization provided after July 1, 2020. The list of services includes:

  • Blepharoplasty

  • Botulinum toxin injections

  • Panniculectomy

  • Rhinoplasty

  • Vein ablation

This published list of outpatient services that will require prior authorization comes from the CY 2020 Outpatient Prospective Payment System Final Rule in which CMS identified these services as potentially improperly billed services. The Administration believes this new prior authorization process will control the number of unnecessary services, saving the Medicare program money.

CMS announced it will continue to release operational information about the new prior authorization process, including how physicians can become exempt from the process. Additional information will be announced on the new CMS Prior Authorization for Certain Hospital Outpatient Department (OPD) Services website.

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About this Author

Sheila Madhani, Senior Director, McDermott Consulting
Senior Director

Sheila advises clients on a wide variety of Medicare payment and regulatory issues. With more than 10 years of experience, Sheila is highly skilled in the areas of Medicare physician and hospital outpatient payment, Medicare quality programs, and the establishment and valuation of CPT® codes. Sheila has a deep understanding of emerging technology’s impact on Medicare reimbursement. She has facilitated relationships and discussions with physician specialty societies and industry stakeholders, helping to develop mutually beneficial collaborations. Sheila also has guided...