In a recent report, the Office of Inspector General found that Medicare improperly paid claims for implanted spinal neurostimulators when providers didn’t provide sufficient documentation supporting medical necessity. For dates of service on or after July 1, 2021, you must ask your Medicare Administrative Contractor to authorize these services before performing the procedure in the hospital outpatient department.

Learn what you need to include in patient medical records:

• Prior Authorization and Pre-Claim Review Initiatives webpage
• Section XVII Calendar Year 2021 Hospital Outpatient Prospective Payment System final rule
• Section 6.3.2.2 Prior Authorization Program for Certain Hospital Outpatient Department Services (PDF) operational guide
• 2021 Final List of Outpatient Department Services That Require Prior Authorization (PDF)
• ASRA Guide to Medicare Prior Authorization for Implanted Spinal Neurostimulator Procedures Performed in Outpatient Hospital Settings