Reminder: OPPS prior authorization requirements take effect July 1

Beginning July 1, certain hospital outpatient department services require prior authorization for payment under the Medicare hospital outpatient prospective payment system final rule for calendar year 2020. The services subject to the prior authorization requirements are blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation. In addition, other related or associated services performed in an outpatient department — such as anesthesiology services, physician services, and facility services — may not be paid if a service requiring prior authorization is not eligible for payment. For more on the provision, see the Centers for Medicare & Medicaid Services’ recent Open Door Forum presentation and the AHA Regulatory Advisory on the 2020 rule.