Proposed Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services (CMS-10711)

The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for adding additional services to the established prior authorization process and requirements for certain outpatient department (OPD) services. This process is under the authority of §1833(t)(2)(F), which authorizes the Secretary to develop a method for controlling unnecessary increases in the volume of covered OPD services. CMS adds OPD services to the prior authorization process through the CY OPPS/ASC final rules. CMS' extensive data analysis of these additional OPD services demonstrated significant increases in the utilization volume. CMS believes a prior authorization process would ensure beneficiaries receive medically necessary care while protecting the Medicare Trust Funds from improper payments and unnecessary utilization.

The latest form for Proposed Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services (CMS-10711) expires 2027-11-30 and can be found here.

Prior Authorization Process (Five Original Categories)

Federal Enterprise Architecture: Health - Health Care Services