Select a State:
Alabama
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOS items subject to Prior Authorization
- Review Choice Demonstration for Inpatient Rehabilitation Facility Services
Review Choice Demonstration for Inpatient Rehabilitation Facility Services
The codes listed in Chapter 3 of the operational guide describe the rehab care received. They indicate the type of rehab facility or hospital unit that provided treatment and whether an overnight stay was required. They also include a code that explains the health conditions, how much care may be needed, and helps Medicare decide how much to pay for the care.
California
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOS items subject to Prior Authorization
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Review Choice Demonstration for Inpatient Rehabilitation Facility Services
Review Choice Demonstration for Inpatient Rehabilitation Facility Services
The codes listed in Chapter 3 of the operational guide describe the rehab care received. They indicate the type of rehab facility or hospital unit that provided treatment and whether an overnight stay was required. They also include a code that explains the health conditions, how much care may be needed, and helps Medicare decide how much to pay for the care.
- Provisional Period of Enhanced Oversight (PPEO)- Hospice
Provisional Period of Enhanced Oversight (PPEO)- Hospice
During a Provisional Period of Enhanced Oversight (PPEO), Medicare monitors some providers more closely for a period of time.
This can include providers that are:- New to Medicare
- Changing ownership
- Reactivating their Medicare billing
During this time, Medicare may review every claim before paying it and ask for medical records to make sure the documentation is complete and care was medically needed.
Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio
Alaska
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
American Samoa
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Arizona
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Provisional Period of Enhanced Oversight (PPEO)- Hospice
Provisional Period of Enhanced Oversight (PPEO)- Hospice
During a Provisional Period of Enhanced Oversight (PPEO), Medicare monitors some providers more closely for a period of time.
This can include providers that are:- New to Medicare
- Changing ownership
- Reactivating their Medicare billing
During this time, Medicare may review every claim before paying it and ask for medical records to make sure the documentation is complete and care was medically needed.
Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio
Arkansas
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Colorado
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Connecticut
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Delaware
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Florida
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Review Choice Demonstration for Home Health Services
Review Choice Demonstration for Home Health Services
Full list of codes can be found in the Operational Guide
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
Georgia
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Provisional Period of Enhanced Oversight (PPEO)- Hospice
Provisional Period of Enhanced Oversight (PPEO)- Hospice
During a Provisional Period of Enhanced Oversight (PPEO), Medicare monitors some providers more closely for a period of time.
This can include providers that are:- New to Medicare
- Changing ownership
- Reactivating their Medicare billing
During this time, Medicare may review every claim before paying it and ask for medical records to make sure the documentation is complete and care was medically needed.
Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio
Guam
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Hawaii
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Idaho
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Illinois
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Review Choice Demonstration for Home Health Services
Review Choice Demonstration for Home Health Services
Full list of codes can be found in the Operational Guide
Indiana
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Iowa
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Kansas
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Kentucky
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Louisiana
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Maine
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Maryland
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
Massachusetts
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Michigan
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Minnesota
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Mississippi
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Missouri
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Montana
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Nebraska
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Nevada
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Provisional Period of Enhanced Oversight (PPEO)- Hospice
Provisional Period of Enhanced Oversight (PPEO)- Hospice
During a Provisional Period of Enhanced Oversight (PPEO), Medicare monitors some providers more closely for a period of time.
This can include providers that are:- New to Medicare
- Changing ownership
- Reactivating their Medicare billing
During this time, Medicare may review every claim before paying it and ask for medical records to make sure the documentation is complete and care was medically needed.
Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio
New Hampshire
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
New Jersey
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
New Mexico
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
New York
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
North Carolina
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Review Choice Demonstration for Home Health Services
Review Choice Demonstration for Home Health Services
Full list of codes can be found in the Operational Guide
North Dakota
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
>
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Northern Mariana Islands
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Ohio
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Review Choice Demonstration for Home Health Services
Review Choice Demonstration for Home Health Services
Full list of codes can be found in the Operational Guide
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Provisional Period of Enhanced Oversight (PPEO)- Hospice
Provisional Period of Enhanced Oversight (PPEO)- Hospice
During a Provisional Period of Enhanced Oversight (PPEO), Medicare monitors some providers more closely for a period of time.
This can include providers that are:- New to Medicare
- Changing ownership
- Reactivating their Medicare billing
During this time, Medicare may review every claim before paying it and ask for medical records to make sure the documentation is complete and care was medically needed.
Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio
Oklahoma
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Review Choice Demonstration for Home Health Services
Review Choice Demonstration for Home Health Services
Full list of codes can be found in the Operational Guide
Oregon
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Pennsylvania
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Review Choice Demonstration for Inpatient Rehabilitation Facility Services
Review Choice Demonstration for Inpatient Rehabilitation Facility Services
The codes listed in Chapter 3 of the operational guide describe the rehab care received. They indicate the type of rehab facility or hospital unit that provided treatment and whether an overnight stay was required. They also include a code that explains the health conditions, how much care may be needed, and helps Medicare decide how much to pay for the care.
Puerto Rico
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Rhode Island
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
South Carolina
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
South Dakota
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Tennessee
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
Texas
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOS items subject to Prior Authorization
- Review Choice Demonstration for Home Health Services
Review Choice Demonstration for Home Health Services
Full list of codes can be found in the Operational Guide
- Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
Prior Authorization Demonstration for Certain Ambulatory Surgical Center ASC Services
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Review Choice Demonstration for Inpatient Rehabilitation Facility Services
Review Choice Demonstration for Inpatient Rehabilitation Facility Services
The codes listed in Chapter 3 of the operational guide describe the rehab care received. They indicate the type of rehab facility or hospital unit that provided treatment and whether an overnight stay was required. They also include a code that explains the health conditions, how much care may be needed, and helps Medicare decide how much to pay for the care.
- Provisional Period of Enhanced Oversight (PPEO)- Hospice
Provisional Period of Enhanced Oversight (PPEO)- Hospice
During a Provisional Period of Enhanced Oversight (PPEO), Medicare monitors some providers more closely for a period of time.
This can include providers that are:- New to Medicare
- Changing ownership
- Reactivating their Medicare billing
During this time, Medicare may review every claim before paying it and ask for medical records to make sure the documentation is complete and care was medically needed.
Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio
US Virgin Islands
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Utah
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Vermont
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Virginia
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Washington
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
West Virginia
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Wisconsin
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Wyoming
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
District of Columbia
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Serviced Involved
- Blepharoplasty
- Botulinum Toxin Injections
- Panniculectomy
- Rhinoplasty
- Vein Ablation
- Implanted Spinal Neurostimulators
- Cervical Fusion with Disc Removal
- Facet Joint Interventions
- Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport
- Advanced Life Support (ALS), non-emergency ambulance
- Basic Life Support (BLS), non-emergency ambulance
- Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
Master list of DMEPOs items subject to Prior Authorization
Program Integrity Demonstrations and Initiatives