Q&A: Submitting prior authorization requests to Medicare

Q: What services will require prior authorization from Medicare starting July 1 and how do we submit prior authorizations to Medicare?

A: The following hospital outpatient department (HOPD) services performed on or after July 1, 2020 will require prior authorization:

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

Prior authorization forms should be submitted to your local Medicare Administrative Contractor (MAC). No specific form is required; however, your local MAC may provide a cover sheet or template for voluntary use. Given that prior authorizations will be required for services performed on or after July 1, MACs will begin accepting the prior authorization requests starting June 17 for requests submitted via fax, mail, and the MAC electronic portals. Submissions via electronic submission of medical documentation (esMDs) will be available beginning July 6.

Editor's note: This question and answer were excerpted from "Note from the instructor: Prior authorization process for certain outpatient services to begin next month," by Yvette DeVay. MHA, CPC, CPMA, CIC.