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April 2, 2020

CMS Adoption of Prior Authorization Requirements—Implications for Facial Plastic Surgery

Author Affiliations
  • 1Harvard Medical School, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2020;146(5):397-398. doi:10.1001/jamaoto.2020.0235

In November 2019, the Centers for Medicare & Medicaid Services (CMS) finalized significant changes to the Medicare Physician Fee schedule.1 As part of this update, CMS announced that, for the first time, the agency would begin implementing a prior authorization (PA) requirement in 2020 for 5 new procedures relevant to the field of facial plastic and plastic surgery: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation. These particular procedures were targeted owing to the significantly increased number of these services submitted as claims compared with the expected number, based on the number of Medicare beneficiaries. Herein, we examine the new policy and its implications to the field of facial plastic and reconstructive surgery, oculoplastic surgery, and plastic surgery.

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