JUN 24, 2020
Prior Authorization for Medicare
Question: I recently heard Medicare requires a prior authorization on blepharoplasties. In the past we’ve been unable to prior authorize services with Medicare. Is this new?
Answer: Yes. Medicare now requires prior authorization for eyelid and Botox procedures when performed in the hospital outpatient department (HOPD) only. Documentation from the surgeon must meet medical necessity, payer requirements and be provided to the HOPD to submit for preauthorization. Otherwise, neither the facility, the surgeon or the anesthesiologist will be paid. If these procedures are performed in the office suite or ambulatory surgery center (ASC), no authorization is required.
For more information including documentation requirements, see the Academy’s webpage.