Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services (CMS-10711)
Revision of a currently approved collection
No
Regular
07/14/2026
Requested
Previously Approved
36 Months From Approved
11/30/2027
847,339
564,010
357,967
316,412
14,529,836
846,013
The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for adding an additional service category 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. In the CY 2020 OPPS/ASC final rule, CMS established criteria for identifying a list of outpatient department services requiring prior authorization and focused on five groups of OPD services â blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, vein ablation, and their related services. As part of the CY 2021 OPPS/ASC Final Rule (CMS -1736-FC), we added two more service categories to the prior authorization process - cervical fusion with disc removal and implanted spinal neurostimulators. Through the CY 2023 OPPS/ASC Final Rule (CMS-1772-FC), CMS added eighth service category to the list of OPD services requiring prior authorization- facet joint interventions. As part of the CY 2027 OPPS/ASC rule, CMS is expanding prior authorization requirements to include additional Botulinum Toxin Injection services. This addition would be incorporated into the existing list of OPD services requiring prior authorization at § 419.83(a) for dates of service provided on or after July 1, 2027. CMS recently completed an analysis of the volume of covered OPD services furnished and recognized significant increases in the utilization volume of these additional services. CMS believes a prior authorization process for these additional services would ensure beneficiaries receive medically necessary care while protecting the Medicare Trust Funds from improper payments and unnecessary utilization.
As part of the CY 2027 OPPS/ASC rule, CMS is expanding prior authorization requirements to include additional Botulinum Toxin Injection services. This addition would be incorporated into the existing list of OPD services requiring prior authorization at § 419.83(a) for dates of service on or after July 1, 2027. Data analysis for this service showed a claim volume increase greater than expected based on the growth rate for OPD services overall. This increase has increased the collections burden.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
CMS-10711.Supporting Statement Part A_.docx
New Services for Botulinum Toxin Injections Category