Does O71.89 require prior authorization?

No, O71.89 does not require prior authorization (high confidence). Code is covered without prior authorization.

`O71.89`, Other specified obstetric trauma

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Has documented at least a 100 pound weight loss;or
Panniculectomy is consideredmedically necessaryfor the individual who meets the following criteria:The panniculus hangs below the level of the pubis (which is documented in photographs);andOneof the following:There are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months;orThere is documented [...]
The panniculus hangs below the level of the pubis (which is documented in photographs);and
Oneof the following:There are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months;orThere is documented difficulty with ambulation and interference with the activities of daily living;and
There are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months;or
There is documented difficulty with ambulation and interference with the activities of daily living;and

ANTHEM-CG-SURG-99, Panniculectomy and Abdominoplasty

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