New prior authorization policy coming down the pipeline, American College of Radiology warns
There is a new prior authorization policy coming down the pipeline in Medicare, the American College of Radiology warned members on Wednesday.
Beginning on July 1, radiologists will need to seek preapproval when performing facet joint interventions in certain hospital outpatient locations. The change applies to CPT codes 64490-64495 and 64633-64636, delivered in both off- and on-campus outpatient hospital locations.
“The new service category is in addition to existing prior authorization services, which include blepharoplasty, botulinum toxin injection, rhinoplasty, panniculectomy, vein ablation, cervical fusion with disc removal and implanted spinal neurostimulators,” ACR said in the Feb. 22 news update. “The prior authorization request must be submitted before the service is provided to the beneficiary and before the claim is submitted for processing,” the college added, noting that CMS will not accept such requests after the service is administered.
The Centers for Medicare & Medicaid Services made this change as part of the 2023 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule, released in November. ACR said radiologists who provide such services should expect to hear from their Medicare Administrative Contractor in the next few weeks.
“CMS will educate physicians and providers about this program by sending the introductory letters attached to this [change request], as well as communicating related requirements and resources to access additional information,” the agency said in a transmittal sent in December.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.