Does E88.82 require prior authorization?

No, E88.82 does not require prior authorization (high confidence). Covered without prior authorization.

`E88.82`, Obesity due to disruption of MC4R pathway

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Document general ophthalmoscopy and biomicroscopy findings in the medical record even when these services are included in extended ophthalmoscopy and not separately billed.
For extended ophthalmoscopy, include a drawing or equivalent documentation that demonstrates the extended nature of the exam to support separate payment.
Orders for CPT 92227 and CPT 92228 must be from the treating physician or other treating practitioner acting within the scope of license and Medicare requirements and this order must be documented in the record.
When extended ophthalmoscopy is performed during a global surgery period and is unrelated to the surgical condition, document the unrelatedness and report modifier -76 or -79 as appropriate.

Extended ophthalmoscopy (CPT 92201, 92202) is payable when documented as an extended ophthalmoscopy that meets indicated standards (e.g., includes a retinal drawing or equivalent documentation) beyond a general ophthalmologic exam.
Fundus photography (CPT 92227, CPT 92228) is covered when ordered by the treating physician or other treating practitioner acting within the scope of his/her license and Medicare requirements.
CPT 92227 is covered when used to evaluate asymptomatic patients at risk with known disease likely to cause retinal disease (e.g., diabetes mellitus) when ordered by the treating physician.
CPT 92228 is a covered service when ordered by the treating physician or other treating practitioner acting within the scope of license and Medicare requirements.
Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
Coverage for ophthalmic angiography (fluorescein and indocyanine green) is determined by the Local Coverage Determination L34426 and applies when that LCD's clinical criteria are met.

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

ANTHEM-CG-SURG-83, Bariatric Surgery and Other Treatments for Clinically Severe Obesity

ANTHEM-CG-LAB-25, Outpatient Glycated Hemoglobin and Protein Testing

A53060, Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography

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