Prior Auth Required

42999 - Unlisted procedure, pharynx, adenoids, or Medical necessity review will be Medical Necessity Review required at claims submission

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceUnlisted procedure, pharynx, adenoids, or Medical necessity review will be Medical Necessity Review required at claims submission
Procedure / Service Description

Code Description Plan Review Requirement Reviewed For Records Request - results of CPAP trial. No review needed for member age 18 and under. 42999 Unlisted procedure, pharynx, adenoids, or Medical necessity review will be Medical Necessity Review required at claims submission; tonsils performed upon claims submission submit description of procedure with with supporting documentation. supporting documentation (including

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.