00802
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Photographic documentation demonstrating the panniculus hangs below the level of the pubis.
- Clinical documentation showing difficulty with personal hygiene, ambulation/walking, or other physical activity due to the panniculus.
- Medical records and photographs documenting at least one chronic/persistent complication under the panniculus.
- Evidence of trials and failure of appropriate medical therapy (topical antifungals; topical/systemic corticosteroids; local/systemic antibiotics) for ≥3 months.
Key Coverage Criteria
- General Anesthesia or Regional AnesthesiaAdministration of general or regional anesthesia is consideredmedically necessarywhen both of the following criteria are met:
- The services are provided by an individual other than the attending physician performing the procedure;and
- Alternative types of anesthesia, sedation, or analgesia are not appropriate.
- If general or regional anesthesia is requested for a procedure typically not requiring either of these levels of anesthesia service, a medical necessity review will be performed. This review will assess not only the procedure involved, but also other individual-specific issues, such as age, mental status, ability to cooperate, co-morbid conditions, and general medical status.
- Monitored Anesthesia Care (MAC)Monitored anesthesia care (MAC) is consideredmedically necessarywhenallof the following criteria are met:
- MAC is requested by the attending physician;and
3 Active Policies
AMBETTER-CP.MP.109 — Panniculectomy
ANTHEM-CG-MED-21 — CG-MED-21 Anesthesia Services and Moderate (âConsciousâ) Sedation
ANTHEM-CG-SURG-99 — CG-SURG-99 Panniculectomy and Abdominoplasty
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.