Does 22999 require prior authorization?

No, 22999 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 22999?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Preoperative photographs demonstrating the pannus hangs at or below the level of the symphysis pubis.
Documentation that the pannus is causing persistent intertriginous dermatitis, cellulitis, or skin ulceration that is refractory to at least three (3) months of medical management.
Documentation of the specific medical management tried for at least three (3) months, including evidence of good hygiene practices and use of topical antifungals, topical and/or systemic corticosteroids, and/or local or systemic antibiotics.
Clinical documentation of the presence of a functional deficit due to a severe physical deformity or disfigurement resulting from the pannus, including how the pannus interferes with activities of daily living.

Panniculectomy is considered medically necessary when ALL of the following conditions are met as demonstrated on preoperative photographs:
The pannus hangs at or below the level of the symphysis pubis.
The pannus is causing persistent intertriginous dermatitis, cellulitis, or skin ulceration, which is refractory to at least three (3) months of medical management, including all applicable treatments. In addition to good hygiene practices, treatment should include topical antifungals, topical and/or systemic corticosteroids, and/or local or systemic antibiotics.
There is presence of a functional deficit due to a severe physical deformity or disfigurement resulting from the pannus.
The surgery is expected to restore or improve the functional deficit.
The pannus is interfering with activities of daily living.

CIGNA-0027 — Panniculectomy and Abdominoplasty - (0027)

ANTHEM-CG-SURG-99 — CG-SURG-99 Panniculectomy and Abdominoplasty

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