Prior Auth Required

43499 - Unlisted procedure, esophagus 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, esophagus Medical necessity review will be Medical Necessity Review required at claims submission
Procedure / Service Description

Code Description Plan Review Requirement Reviewed For Records Request - peroral endoscopic myotomy [POEM]) Optional 43499 Unlisted procedure, esophagus Medical necessity review will be Medical Necessity Review required at claims submission; 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.