---
kind: "section"
citation: "42 C.F.R. § 419.83"
title: "42"
number: "419.83"
heading: "List of hospital outpatient department services requiring prior authorization."
url: "https://uscodex.org/cfr/42/419.83"
---

# §419.83. List of hospital outpatient department services requiring prior authorization.

- (a) **Service categories for the list of hospital outpatient department services requiring prior authorization.**
  - (1) The following service categories comprise the list of hospital outpatient department services requiring prior authorization beginning for service dates on or after July 1, 2020:
    - (i) **Blepharoplasty.**
    - (ii) **Botulinum toxin injections.**
    - (iii) **Panniculectomy.**
    - (iv) **Rhinoplasty.**
    - (v) **Vein ablation.**
  - (2) The following service categories comprise the list of hospital outpatient department services requiring prior authorization beginning for service dates on or after July 1, 2021:
    - (i) **Cervical Fusion with Disc Removal.**
    - (ii) **Implanted Spinal Neurostimulators.**
  - (3) The Facet Joint Interventions service category requires prior authorization beginning for service dates on or after July 1, 2023.
- (b) **Adoption of the list of services and technical updates.**
  - (1) CMS will adopt the list of hospital outpatient department service categories requiring prior authorization and any updates or geographic restrictions through formal notice-and-comment rulemaking.
  - (2) Technical updates to the list of services, such as changes to the name of the service or Current Procedural Terminology (CPT) code, will be published on the CMS website.
- (c) **Exemptions.** CMS may elect to exempt a provider from the prior authorization process in [§ 419.82](/cfr/42/419.82.md) upon a provider's demonstration of compliance with Medicare coverage, coding, and payment rules in chapter IV of this title or in Title XVIII of the Social Security Act through such prior authorization process.
  - (1) An exemption will remain in effect until CMS elects to withdraw the exemption.
  - (2) Notice of an exemption or withdraw of an exemption will be provided at least 60 days prior to the effective date.
- (d) **Suspension of prior authorization process or services.** CMS may suspend the outpatient department services prior authorization process requirements generally or for a particular service(s) at any time by issuing notification on the CMS website.

## Notes

### Amendments

[84 FR 61491, Nov. 12, 2019, as amended at 85 FR 86303, Dec. 29, 2020; 87 FR 72292, Nov. 23, 2022]

### Source

Source: 84 FR 61491, Nov. 12, 2019, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302, 1395l(t), and 1395hh.

### Source

Source: 65 FR 18542, Apr. 7, 2000, unless otherwise noted.

### Amendments

[84 FR 61491, Nov. 12, 2019, as amended at 85 FR 86303, Dec. 29, 2020; 87 FR 72292, Nov. 23, 2022]