Does E66.2 require prior authorization?

No, E66.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E66.2`, Morbid (severe) obesity with alveolar hypoventilation

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims for covered bariatric surgery must include three diagnosis codes with the primary diagnosis as E66.01, E66.812, or E66.813 and secondary/tertiary diagnoses from the specified ICD-10-CM code groups (group 1 and group 2).
When using CPT 43843 or CPT 43999 to bill a Not Otherwise Classified (NOC) or specific open procedures, include a note identifying the specific test/procedure performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Refer to LCD L35022 for complete reasonable-and-necessary documentation requirements and retain supporting medical records as required by Medicare policy.
Claims must document medical necessity and meet the reasonable and necessary requirements specified in Novitas LCD L35050.

Coverage for selected bariatric surgical procedures is allowed only for patients who meet the national and local reasonable-and-necessary criteria set forth in LCD L35022.
Claims for covered bariatric procedures must report three diagnoses: a primary diagnosis of morbid obesity (one of E66.01, E66.812, or E66.813), a secondary diagnosis from ICD-10-CM Code group 1, and a tertiary diagnosis from ICD-10-CM Code group 2.
Use CPT 43659 when both the gastric band and the subcutaneous port components were removed and replaced in the same encounter.
Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.
Home sleep testing performed with a WatchPAT device should be billed with CPT code 95800 or 95801.
Actigraphy may be reported with CPT code 95803 to document CPAP coverage under the applicable NCD or as follow-up CPAP administration when accepted by the DME contractor.

NGS-J6-L37535, Vitamin D Assay Testing

A57736, Billing and Coding: Vitamin D Assay Testing

FIRST_COAST-L33756, Transesophageal Echocardiogram

FIRST_COAST-L33411, Surgical Management of Morbid Obesity

A57145

Ask Backwork about documentation requirements, denial risks, or coverage in your state.