Does E66.89 require prior authorization?

No, E66.89 does not require prior authorization (high confidence). Covered without prior authorization.

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`E66.89`, Other obesity not elsewhere classified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include appropriate patient identification and dates of service.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
If the provider performing the TEE is different from the ordering/referring physician, the performing provider must retain hard copy documentation of test results and interpretation and copies of the ordering/referring physician's order.

Key Coverage Criteria

Coverage of transesophageal echocardiogram (TEE) is determined by the reasonable and necessary clinical criteria in Local Coverage Determination L33756; refer to LCD L33756 for specific covered indications.
Gastric bypass and gastric restrictive procedures are consideredmedically necessarywhenallof the following criteria are met:
Individual is age 18 years or older;and
The recommended surgery is one of the following procedures:Biliopancreatic bypass with duodenal switch;orEndoscopic sleeve gastroplasty;orLaparoscopic adjustable gastric banding;orRoux-en-Y procedure up to 150 cm;orSingle anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S);orDuodenal jejunal bypass with gastric sleeve (DJB-SG);orSleeve gastrectomy;and
Biliopancreatic bypass with duodenal switch;or
Endoscopic sleeve gastroplasty;or

14 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-J18-L40199, MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J18

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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E66.89, Other obesity not elsewhere classified