§419.83. List of hospital outpatient department services requiring prior authorization. — Inbound Citations

As used in this subpart, unless otherwise specified, the following definitions apply:

(a) As a condition of Medicare payment for the services in the categories of services on the list of hospital outpatient department services requiring prior authorization as specified in § 419.83(a), a provider must submit to CMS or its contractors a prior authorization request in accordance with the requirements of paragraph (c) of this section.

As used in this subpart, unless otherwise specified, the following definitions apply:

(1) CMS or its contractors will deny a claim for a service that requires prior authorization if the provider has not received a provisional affirmation of coverage on the claim from CMS or its contractor unless the provider is exempt under § 419.83(c).