Prior Auth Required

43242 - Esophagogastroduodenoscopy, flexible, Prior Authorization Required Medical Necessity Submit History and Physical, procedure

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceEsophagogastroduodenoscopy, flexible, Prior Authorization Required Medical Necessity Submit History and Physical, procedure
Procedure / Service Description

transoral; with directed submucosal documentation of medical necessity and - transoral; with biopsy, single or multiple report. No review needed for member age 18 and under. 43242 Esophagogastroduodenoscopy, flexible, Prior Authorization Required Medical Necessity Submit History and Physical, procedure transoral; with transendoscopic ultrasound- report. No review needed for member age guided intramural or transmural fine needle 18 and under.

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.