Does Z46.51 require prior authorization?

No, Z46.51 does not require prior authorization (high confidence). Covered without prior authorization.

`Z46.51`, Encounter for fitting and adjustment of gastric lap band

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must be submitted in accordance with CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 32 Section 150 (Billing Requirements for Bariatric Surgery for Morbid Obesity), including use of the procedure and diagnosis codes listed there and in this local article.
Coverage for Type II diabetes mellitus complication diagnosis codes is based on the Internet Only Manual (IOM); include documentation and citations required by IOM when billing these diagnoses.
Bariatric surgery claims must reference the applicable national coverage determination (CMS Pub 100-03 Chapter 1 Part 2 Section 100.1) when submitting for payment.
All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.

Bariatric surgery for treatment of co-morbid conditions related to morbid obesity is payable when billed in accordance with CMS Pub 100-03 Medicare National Coverage Determinations Manual, Chapter 1 Part 2 Section 100.1.
Additional diagnoses listed in this local coverage article for Part A procedure codes and the article's listed CPT codes are covered for bariatric surgery to treat co-morbid conditions related to morbid obesity.
Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
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

A54923, Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity

NOVITAS-JH-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

NOVITAS-JL-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

A57414, Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

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