Does E66.9 require prior authorization?

No, E66.9 does not require prior authorization (high confidence). Covered without prior authorization.

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`E66.9`, Obesity, unspecified

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.
Surgical management of morbid obesity (referenced LCD L33411 / A57145 — First Coast Service Options).
No specific covered indications are stated in this document. The policy defers coverage determinations to applicable CMS NCDs/LCDs/LCAs and the local Medicare Administrative Contractor (MAC).
Exact text: 'Humana and subsidiaries apply a Medicare Administrative Contractor's (MAC's) LCD to all requests (both Part A and Part B services) within the MAC's applicable geographic jurisdiction.'
Related policies referenced (not stated as covered indications here): 'Gastric Pacing/Gastric Electrical Stimulation' and 'Vagus Nerve Stimulation'
Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity (NCD 100.1).

20 Active Policies

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

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

J18

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E66.9, Obesity, unspecified