General Documentation Requirements for Rhinoplasty and Related Services
Checklist of prior authorization request (PAR) information to include:
- Medical documentation, with evaluation and management, supporting medical necessity of the service that is to be performed
- Radiologic imaging if done
- Photographs that document the nasal deformity (if applicable)
- Documentation supporting unresponsiveness to conservative medical management (if applicable)
This checklist is not all inclusive; please submit any additional medical records that help support the medical necessity of the Hospital Outpatient Department service.
A facility or the beneficiary may submit the PAR and supplemental documentation via NGSConnex, esMD, fax or mail.
- NGSConnex
- YouTube instructional video on submitting through NGSConnex
- esMD: Content type 8.5
- Fax
- JK: 317-841-4530
- J6: 317-841-4528
- Mail
National Government Services, Inc.
Attention: Medical Review Prior Authorization Request
P.O. Box 7108
Indianapolis, IN 46207-7108
Provider Contact Center Inquiry Line:
- JK: 888-855-4356
- J6: 877-702-0990
Related Content:
- 42 Code of Federal Regulations 410
- Section 1842(P)(4) of The Social Security Act
- Centers for Medicare & Medicaid Services Internet-Only Manuals (IOMs) Publications:
- CMS IOM Publication 100-08, Chapter 3, Sections 3.6.2.2, 3.3.2.4, 3.6.2.2 and 3.2.3.8
- CMS IOM Publication 100-02, Chapter 15, Section 80.6.1