Does E66.811 require prior authorization?

No, E66.811 does not require prior authorization (high confidence). Covered without prior authorization.

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`E66.811`, Obesity, class 1

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
Hospital inpatient claims must report the principal diagnosis in UB-04 Form Locator 67 and up to eight additional ICD-10-CM codes in FL 67A-67Q; admitting diagnosis is required in FL 69.
Hospital outpatient claims must report the full ICD-10-CM code for the diagnosis chiefly responsible for the outpatient services in FL 67, or the presenting symptom or Z00.00–Z13.9 if no definitive diagnosis.
The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report to support medical necessity.

Key Coverage Criteria

Outpatient psychiatry and psychology services are payable under Medicare Part B when provided in accepted places of service listed (e.g., office 11, outpatient hospital 22, telehealth in patient's home 10, etc.).
Services of physicians, clinical psychologists, physician assistants, nurse practitioners, and clinical nurse specialists should be billed to the Part B Medicare Administrative Contractor (MAC).
Individual psychotherapy CPT codes must be used when the primary focus of the treatment encounter is psychotherapy.
When the visit is primarily psychotherapy and also includes pharmacological management, bill the appropriate psychotherapy code (which includes E/M) and CPT 90863 for pharmacological management in addition.
For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
For diagnostic tests, report the test result if known; if not known, report the symptom that prompted the test.

17 Active Policies

CGS-J15-L40198, MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J15

CGS-J15-L40199, MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J15

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

CGS-J18-L40198, MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J18

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E66.811, Obesity, class 1