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Is Your Medicare Carrier Requiring Prior Authorization for a Septoplasty?

We were surprised to hear this from more than one client! So we did some investigating. 

First, remember our KZAlert from July 9, 2020 [view here] announcing Medicare’s new prior authorization process? The procedures that require prior authorization are: 

  • Blepharoplasty
  • Botulinum toxin injections
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

Recall, the prior authorization is for the facility payment, not the surgeon’s reimbursement. However, many facilities require the physician to perform the prior authorization. A septoplasty is not on the above list, so why are we emailing you? 

Look at this Palmetto GBA prior authorization request form

Scroll down to page 2 and look at the codes required for “Rhinoplasty” prior authorization. Yes, you read that right - a septoplasty! How is a septoplasty considered a rhinoplasty? we ask. Good grief!

So now you know why your Medicare carrier may require facility prior authorization for a septoplasty.
Evaluation & Management 2.0 Workshop
2021 E/M Guidelines for Otolaryngology
Insist on otolaryngology specific training

This fast-moving, information-filled 3-hour virtual presentation, led by expert Kim Pollock, RN, MBA, CPC, CMDP will provide answers to the most common and one-off coding questions. And, there will be time for your questions.

CEUs are available upon completion of the course and a brief evaluation.

Upcoming dates:
Saturday, February 20th | 8 AM - 11 AM CST
Thursday, February 25th | 2 PM - 5 PM CST

Find out more about this course here.
Advising physicians to succeed in the business of medicine.