Wegovy j code. •Administer WEGOVY once weekly, on the same WEGOVY is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). 5 ml in 1 syringe, plastic (0169-4525-01) of Wegovy, a human prescription drug labeled by Novo Nordisk. 2)]. Xenical A reversible inhibitor of gastrointestinal lipases. Coding Implications Codes referenced in this clinical policy are for informational purposes only. The product is distributed in 2 packages with assigned NDC codes 0169-4132-12 1 syringe, plastic in 1 carton / 1. 25 mg / 0. com, including related drug classes, side effects, dosage, and answers to frequently asked questions. See full prescribing information for WEGOVY. COVERAGE POLICIES RELATE EXCLUSIVELY TO THE ADMINISTRATION OF HEALTH BENEFIT PLANS. How much does Wegovy cost without insurance? Before using your pen for the first time, read the Instructions for Use and Medication Guide that come with your pen pack, and talk to your health care provider about how to use WegovyTM correctly. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the Wegovy or Zepbound will be approved based on both of the following criteria: Weight loss of ≥ 5% of baseline body weight -AND- Continuation of lifestyle modification Authorization will be issued for 12 months. 25 Line of Business: Commercial Access information about your Wegovy® weight‐loss prescription to learn more. Jan 11, 2025 · With an estimated list price of $1,430 per month, the cost of Wegovy is very high, especially for those without adequate insurance coverage. 75 mL Injection 4 Pens by Novo Nordisk Pharma Inc 00169452414 Save at Wegovy with top coupons & promo codes verified by our experts. Jun 19, 2021 · Avoid cost pitfalls and maintain quality treatment. , anaphylaxis, angioedema) have been reported with Wegovy ®. 4 mg / 0. •Administer WEGOVY once weekly, on the same Diagnosis Code: ____________ Please select the requested medication and answer the following questions for CONTINUATION coverage: Saxenda Wegovy Zepbound 1. WEGOVY 2. The HCPCS codes range Drugs, Administered by Injection J0120-J7175 is a standardized code set necessary for Medicare and other health insurance providers to provide healthcare claims. WEGOVY (semaglutide) injection, for subcutaneous Many health plans require a Letter of Medical Necessity when appealing a coverage determination or prior authorization for a patient’s plan. Aug 28, 2025 · This web page contains comprehensive information about NDC Code 0169-4525-14. Clinical Policy: Tirzepatide (Zepbound) Reference Number: CP. KEY DETAILS On Dec. 4 mg In addition to diet and exercise, to reduce risk of MACE (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CVD and either overweight or obesity, and for chronic weight management in patients with obesity ≥12 years and adults with overweight with at least one weight-related comorbidity. Wegovy® is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Has the patient had at least 3 months of lifestyle modifications? Wegovy® (semaglutide) injection 2. Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Self-Administered Drug Exclusion List:. Xenical forms a covalent bond with the serine residue site of gastric acid and pancreatic lipases, thus rendering pancreatic lipase from hydrolyzing dietary fat into absorbable free fatty acids (FFA) and Food and Drug Administration Sep 10, 2024 · HCPCS codes may be used for certain weight loss medications‚ particularly those that are not covered by standard CPT codes. 2017;13(3):479-504. * The Purpose of a Letter of Medical Necessity is to explain the prescribing healthcare provider’s (HCP’s) rationale and clinical decision-making when choosing a treatment. Sep 5, 2025 · 2. Feb 11, 2024 · Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is approved by the US Food and Drug Administration (FDA) as 3 separate brand name medications—Ozempic®, Wegovy®, and Rybelsus®. Injection and infusion medications may be self-administered or administered by a caregiver, by a home health agency, in a hospital, or in a provider’s office. Choose the best offers & deals for September 2025! Complete details for NDC 00169-4501-14 WEGOVY 1 mg/. Aug 1, 2025 · Instructions for Use - WEGOVY® (semaglutide) injection - WEGOVY comes in five strengths: Before you use your WEGOVY pen for the first time, talk to your healthcare provider or your Aug 20, 2021 · I am looking for a J code for Wegovy and Victoza both are injectable meds. 4 Ozempic is an injectible non-insulin antidiabetic medication, so you This medication has been identified as Wegovy 2. Kapur VK, Auckley DH, Chowdhuri S, et al. Additional PCMH Program Information Drug Rebate J-Codes on Professional Claims Aug 19, 2025 · Without insurance, Wegovy can cost around $1,350 or more for a 28-day supply. Read more now! Learn more about CPT® code 96372 for injection of drug or substance under skin or into muscle. 25Mg/0. All three medicines rely on lifestyle changes to work properly, but semaglutide at the doses used in Wegovy consistently delivers the strongest overall weight loss. Counsel patients regarding the potential risk of MTC and symptoms of thyroid tumors (4, 5. Please see Important Safety Information throughout and on pages 7-8, including Boxed Warning about possible thyroid tumors, including thyroid cancer, and accompanying full Prescribing Information . 25 mg/. Only use if solution is clear, colorless, and contains no particles. , hypertension, type 2 diabetes mellitus, or WEGOVY (semaglutide) injection, solution NDC Code (s): 50090-5824-0 Packager: A-S Medication Solutions This is a repackaged label. NDC 0169-4525 WEGOVY Semaglutide WEGOVY is a Subcutaneous Injection, Solution in the Human Prescription Drug category. Jul 18, 2025 · Learn how to correctly use HCPCS code J3490 for billing unclassified drugs, with tips to ensure clean claims and avoid reimbursement delays. 25 dose, 4 weeks on 0. Sep 5, 2025 · Wegovy List of products in the National Drug Code with proprietary name wegovy. HCPCS 'J' Codes (1162) Drugs Administered Other Than Oral Method, Chemotherapy Drugs Sample diagnostic and billing codes you may find helpful when writing PAs Below are some commonly used ICD-10 codes related to the FDA-approved indications for Wegovy®. Each brand name comes with its own associated indications, preparations, and dosages to consider. that may help adults and children aged 12 years and older with obesity, or some adults Description Item No. May 30, 2024 · Seeking insurance coverage for Wegovy? Use this 2025 guide to give yourself the best chance for successful prior authorizations and what to do if denied. . Search by CPT codes, descriptions and drug names. Providers should reference the most up-to-date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services. Sep 1, 2025 · See our precertification lists or utilize our CPT code lookup to see whether a procedure or service requires prior approval. The safety and effectiveness of WEGOVY in combination with other products intended for weight loss, including prescription drugs, over-the-counter drugs, and herbal preparations, have not been Oct 2, 2023 · While you can purchase generic Semaglutide (Brand names of Ozempic, Wegovy and Rybelsus) at local pharmacies or online, the FDA recommends obtaining it only with a prescription from a licensed medical professional. 7 mg or 2. Can I count as medication management due to FDA recommendation or still NO Prior Authorization Criteria Update: Semaglutide Purpose: This update reviews the evidence for the use of semaglutide (WEGOVY) in patients with cardiovascular (CV) disease who are overweight or obese. Includes verified codes and single-use codes & more. The NDC Packaged Code 0169-4505-14 is assigned to a package of 4 syringe, plastic in 1 carton / . 4 mg/. Jan 27, 2025 · Medicare Coverage of Wegovy Medicare Part D may cover Wegovy for conditions like diabetes, obesity, and cardiovascular disease, offering support for seniors managing their health. Wegovy Wegovy is a GLP-1 receptor agonist that activates GLP-1 receptors, thus regulating appetite and caloric intake. Which insurance benefit processes the medication claim matters. The generic name of Wegovy is semaglutide. fda. CLAIMS SUBMITTED FOR SERVICES THAT ARE NOT ACCOMPANIED BY COVERED CODE(S) UNDER THE APPLICABLE COVERAGE POLICY WILL BE DENIED AS NOT COVERED. a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Semaglutide is used with a proper diet and exercise program to control high blood sugar in people with type 2 diabetes. Any federal regulatory requirements and the member specific benefit plan coverage may also impact coverage Contraindications to Wegovy (semaglutide) include: a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), prior serious hypersensitivity reaction to semaglutide or to any excipients in Wegovy (serious hypersensitivity reactions, including anaphylaxis and Promo Terbaru Aceh4D Toto Togel Online Dengan RTP Tinggi Rasakan sensasi menang besar dengan RTP tinggi hingga 98% dan bonus free spins melimpah setiap hari di platform terpercaya Aceh4D. The generic name of Ozempic is semaglutide. Jan 24, 2024 · Our J-Code lookup tool allows you to find all of the HCPCS (Healthcare Common Procedure Coding System) J-code (and Q-code) drugs and their respective HCPCS Details. Counsel patients regarding the potential risk for MTC with the use of Wegovy® and inform them of symptoms of thyroid tumors (e. Nov 30, 2022 · Complete details for NDC 00169-4517-14 WEGOVY 1. 5 mg/. Here, we will explore the various ways the semaglutide J Code influences these areas. to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight. Eligible* patients can take advantage of a special $25 ofer for up to 6 fills *Eligibility and restrictions apply. The CV benefits of Wegovy are likely due to both direct and indirect effects. Can anyone help with this? Learn how to use the correct CPT codes for Wegovy, a prescription medication for chronic weight management, to ensure proper reimbursement. Find out about ways to save on the price of Wegovy. GPI: 6125207000D525 Comprehensive guide on semaglutide coding for diabetes and obesity, including ICD-10 codes, documentation requirements, and common pitfalls. The primary component is Semaglutide. Jun 7, 2024 · Our office does complete code capture, but we are not clear if we can add Z79. Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. While some evidence suggests that CV benefit may be partially due to the reduction of visceral fat, CV benefit is most likely also resulting from direct cardiac effects. Feb 25, 2025 · The semaglutide J Code is a crucial element in the modern healthcare landscape. Over-the-counter (OTC) products are not included unless otherwise stated. Explore approved indications for Wegovy®. Jun 11, 2024 · Find patient medical information for Wegovy (semaglutide) on WebMD including its uses, side effects and safety, interactions, pictures, warnings, and user ratings Order Wegovy® Semaglutide 0. When billing for lifestyle therapy, use CPT code 99401 (preventive counseling and/or risk factor reduction intervention provided to an individual) along with modifier 33 (for preventive service), Z code Z71. 5mL including product information, packaging information, pricing, prescribing information and package photos. 25 Line of Business: HIM, Medicaid The NDC code 0169-4132 is assigned by the FDA to the product Ozempic which is a human prescription drug product labeled by Novo Nordisk. 5 Inj 4X0. The NDC Packaged Code 0169-4501-14 is assigned to a package of 4 syringe, plastic in 1 carton / . Aug 19, 2025 · Wegovy (semaglutide) is an FDA-approved weekly injection for weight loss, reducing heart risks. 5 By Novo Nordisk USA Only Physician,Pharmacy Or Licensed Facility Can Order This RX WEGOVY (semaglutide) injection, solution NDC Code (s): 50090-5824-0 Packager: A-S Medication Solutions This is a repackaged label. The Letter of Medical Necessity may be helpful to complete along with a Prior Supporting tables: a collection of information associated with the steps within the criteria (diagnosis codes, procedure codes, and therapy codes); provided when applicable References: clinical publications and sources relevant to this clinical criteria Note: Click the hyperlink to navigate directly to that section. The NDC code 0169-4501 is assigned by the FDA to the product Wegovy which is a human prescription drug product labeled by Novo Nordisk. 5 ml in 1 syringe, plastic (0169-4501-01) of Wegovy, a human prescription drug labeled by Novo Nordisk. Important Safety Information for Wegovy ® WARNING: RISK OF THYROID C-CELL TUMORS In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. 1 STEP 1, 2, 3, and 5 were randomized, double Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Self-Administered Drug Exclusion List: (SAD List). 5 ml in We would like to show you a description here but the site won’t allow us. 24 Last Review Date: 05. Recommendations for prior authorization (PA) criteria to allow coverage of semaglutide (WEGOVY) for secondary prevention of major CV events will be presented. State mandates may apply. Mar 27, 2025 · I share proven strategies for navigating insurance for Zepbound, Wegovy, Ozempic, and Mounjaro, including tips on prior authorization, alternative diagnoses, and cash-pay options to help you secure coverage. 85 when an obese patient is prescribed Wegovy for weight loss, but does not have diabetes. accessdata. This program included trials in adults and 1 trial in pediatric patients, to evaluate Wegovy® for weight reduction and long-term maintenance of body weight in conjunction with lifestyle intervention (diet and exercise counseling). If hypersensitivity reactions occur, discontinue use of Wegovy ®, treat promptly per standard of care, and monitor until signs and symptoms resolve. A list of designated medical and surgical services and select prescription Drugs that require prior authorization under the medical benefit. 4 mg. RX732268, 732268, Ndc# 00169-4525-14 00169-525-14 0016952514 00169452514 Upc Code: 3-01694-52514-6 301694-525146 301694525146 Wegovy 0. These codes are used to report injectable drugs that ordinarily cannot be self-administered; chemotherapy, immunosuppressive drugs and inhalation solutions as well as some orally administered drugs. Click for Save on Wegovy® and get personalized support to get the most out of your treatment. 2. Source NDC Code (s): 0169-4525 < previous | page of 1 | next > Our clinical criteria documents include information for all benefit-covered injectable, infused, or implanted prescription drugs and therapies. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin. You can also always call a WeGoTogetherTM Coach at 1-833-4-WEGOVY. 5, and now am about to finish the month of 1. The product is distributed in a single package with assigned NDC code 0169-4501-14 4 syringe, plastic in 1 carton / . Yes, Wegovy is more effective when combined with diet and exercise, and it outperforms Saxenda and Trulicity in clinical trials when used under the same conditions. Read Important Safety and Prescribing Info, including Boxed Warning. 1). Wegovy (semaglutide) is not only superior at reducing body weight compared with other antidiabetic drugs, but it is also cardioprotective. 31. 5 ml in 1 syringe, plastic (0169-4517-01) of Wegovy, a human prescription drug labeled by Novo Nordisk. 7 mg/. For comprehensive instructions and additional codes, please refer to a coding resource1 Complete details for NDC 00169-4505-14 WEGOVY 0. GPI: 6125207000D535 • For Wegovy only: Adults with BMI ≥ 27 kg/m2 AND has established cardiovascular disease (CVD) and NOT have a history of type 1 nor type II diabetes. 2 Important Administration Instructions •Prior to initiation of WEGOVY, train patients on proper injection technique. Work with your health care professional to determine which dose is right for you. Source NDC Code (s): 0169-4525 Clinical Policy: Semaglutide (Wegovy) Reference Number: CP. Animal models have demonstrated anti-inflammatory and anti-atherosclerotic effects of GLP-1 RAs. g. 2024;391:1193-1205. Wegovy ® (semaglutide) injection 2. Apr 23, 2024 · These highlights do not include all the information needed to use WEGOVY safely and effectively. 75mL including product information, packaging information, pricing, prescribing information and package photos. 4 mg is an injectable prescription medicine used with a reduced calorie diet and increased physical activity: to reduce the risk of major cardiovascular events such as death, heart attack, or stroke in adults with known heart disease and with either obesity or overweight. Find out about your estimated cost for Wegovy® and whether your insurance plan covers it. Find drug information for Wegovy on CVS. Learn how Statcare can help you with this innovative treatment. Novo Nordisk reserves the right to modify or cancel this program at any time. 4 mg is indicated in combination with a reduced calorie diet and increased physical activity: to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight to reduce excess body Apr 7, 2025 · Codes listed in this policy are for reference purposes only and may not be all-inclusive or applicable for every state or line of business. In this document, you will learn: What is a J Code? How can you avoid this pitfall and maintain quality treatment for patients? What options are available? What control do I have over these costs? Indications and Usage WegovyTM (semaglutide) injection 2. Refer to the accompanying Instructions for Use for complete administration instructions with illustrations. Initial Prior Authorization with Quantity Limit Wegovy Weight Loss Management Products Referenced by this Document Drugs that are listed in the following table include both brand and generic and all dosage forms and strengths unless otherwise stated. 4 mg WEGOVY for up to 68 weeks and a 7-week off-drug follow-up period [see Clinical Studies (14. 21 Last Review Date: 05. Established CVD is defined as: history of myocardial infarction, stroke, or symptomatic peripheral arterial disease. News details - Novo Nordisk News details Find out how eligible patients can access the Wegovy® savings card and learn more about cost support. Manufacturers of WEGOVY that have been granted an NDC (National Drug Code). Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. The product's dosage form is injection, solution and is administered via subcutaneous form. gov Sep 9, 2025 · This article reviews the safety, efficacy, and regulatory concerns related to compounded semaglutide, with a focus on how health care providers can offer guidance and education to patients. 65 diagnosis and is on Lipitor, Norvasc, Plavix, Omeprazole and Ozempic. In 11 weeks, I spent 4 weeks on the 0. Inclusion or exclusion of any codes does not guarantee coverage. 4 mg is indicated as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of ≥30 kg/m2 (obesity) or ≥27 kg/m2 (overweight) in the presence of at least one weight-related comorbid condition (e. Drug products are identified by unique numerical product identifiers, called National Drug Codes (NDC), which identify the manufacturer, strength, dosage form, formulation and package size. GLP1-RAs also reduce blood pressure and increase Understand the difference between Mounjaro, Ozempic, Wegovy, and Zepbound. 24 Last Review Date: 02. It is labeled and distributed by Novo Nordisk. This example is for illustrative purposes only. Plans may be paying two-fold, three-fold, or more for the cost of a drug. The list includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to payment authorization. See Prescribing Info & Medication Guide. GPI: 6125207000D540 WEGOVY contains semaglutide and should not be coadministered with other semaglutide-containing products or with any other GLP-1 receptor agonist. Use our prior authorization search tool to determine if prior authorization is required. WeGoTogether®What is Wegovy®? WEGOVY ® (semaglutide) injection 2. 5 mL Injection 4 Pens by Novo Nordisk Pharma Inc 00169450514 Apr 24, 2024 · The FDA recently approved a new use for Wegovy, the blockbuster anti-obesity drug, to reduce the risk of heart attacks and stroke in people with cardiovascular disease who are overweight or obese 5 days ago · FQHC PCMH Billing Instructions Primary Care Clinics PCMH Billing Instructions PCMH Quality Performance Measures 2015 PCMH Quality Performance Measures 2016 PCMH Performance-Based Payment Program For additional information on the PCMH program, select the link below. CPT Code 96372⁚ Therapeutic Injections This code covers the administration of weight loss medications that are injected‚ such as GLP-1 receptor agonists (e. Learn how these medications work, their benefits, and their side effects. Listing of a service or device code in this policy does not guarantee coverage. CPA. These may be symptoms The safety and eficacy of Wegovy® for the weight management trials was studied in the STEP clinical trial program. Navigate the Cigna Healthcare precertification process, and ensure your patients receive timely care by understanding our prior authorization requirements. The FDA approved a new use for a drug to reduce the risk of serious heart problems in adults with cardiovascular disease and either obesity or overweight. 4 mg Subcutaneous Weekly Dosage WEGOVY was evaluated for safety in 3 randomized, double-blind, placebo-controlled trials that included 2,116 adult patients with obesity or overweight treated with 2. 1,2 Actor Portrayal. GPI: 6125207000D520 Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Self-Administered Drug Exclusion List:. PMN. •Inspect WEGOVY visually prior to each injection. POLICY STATEMENT Prior Authorization is recommended for prescription benefit coverage of Saxenda, Wegovy, and Zepbound. Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Self-Administered Drug Exclusion List: Medical Policy Article. Read important safety and prescribing info, including Boxed Warning. 352 Effective Date: 09. May 9, 2024 · Contraindications to Wegovy (semaglutide) include: a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), prior serious hypersensitivity reaction to semaglutide or to any excipients in Wegovy (serious hypersensitivity reactions, including anaphylaxis and Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Self-Administered Drug Exclusion List:. All based on real experience! Jun 7, 2024 · Our office does complete code capture, but we are not clear if we can add Z79. Jul 16, 2017 · BuyandBill. Read on to learn how to get Wegovy for $25 per month or at the lowest possible price and potential alternatives. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Another significant benefit of semaglutide is that it can be used for long- term management of weight. Routine monitoring of serum calcitonin or Wegovy® may afect the way some medicines work and some medicines may afect the way Wegovy® works. 5 mL Injection 4 Pens by Novo Nordisk Pharma Inc 00169452514 Aug 31, 2024 · Find all Wegovy promo codes and savings opportunities, tracked in real-time. WHEN BILLING, PROVIDERS MUST USE THE MOST APPROPRIATE CODES AS OF THE EFFECTIVE DATE OF THE SUBMISSION. com re-publishes the self-administered drug exclusion list from CMS. 295 Effective Date: 06. Discover the CPT code for Wegovy and its significance in healthcare. See terms and conditions at Mar 8, 2024 · Indications and Usage Wegovy ® (semaglutide) injection 2. Find the primary CPT codes for Wegovy administration and counseling, and consult the CPT code guidelines and updates. It is unknown whether Wegovy® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of Wegovy Prescribing Information and Medication GuideImportant Safety Information What is the most important information I should know about Wegovy®? Wegovy® may cause serious side effects, including: Possible thyroid tumors, including cancer. 3 (for dietary counseling and surveillance), and BMI Z code Z68. 5 ml in 1 misc-hcpcs-drugs-requiring-authorization Discover how Wegovy® (semaglutide) aids in adults with obesity or some with overweight. 5 ml in 1 syringe, plastic (0169-4505-01) of Wegovy, a human prescription drug labeled by Novo Nordisk. 359 Effective Date: 03. 25 mg once weekly, and you will gradually increase your dose every 4 weeks until you reach your maintenance dose of either 1. Clinical prior Wegovy ® is not recommended in patients with severe gastroparesis Hypersensitivity Reactions: Serious hypersensitivity reactions (e. Wegovy helps reduce appetite and promote lasting weight management. 4 mg/0. “Wegovy ” (aka “Semaglutide”) is a human prescription drug product labeled by “Novo Nordisk”. The NDC Packaged Code 0169-4517-14 is assigned to a package of 4 syringe, plastic in 1 carton / . Deleted codes and codes which are not effective at the time the service is rendered may not be eligible for reimbursement. Frequently Used ICD-10 Codes Get quick access to commonly used ICD-10 codes related to the FDA-approved indications for Wegovy ® as well as sample CVD diagnostic codes. Some less commonly used codes may be missing. ‚ Wegovy‚ Ozempic). Wegovy ® dosing schedule The starting dose of Wegovy® is 0. For six 28-day fills for eligible commercially insured patients with coverage for branded anti-obesity medications, whose coverage is confirmed via a benefits verification. Order Wegovy® Semaglutide 0. Order Wegovy® Semaglutide 2. 01. 27, 2024, HHSC will add formulary coverage for Wegovy (semaglutide) based on the Federal Drug Administration (FDA) expanded indication for the risk reduction of major adverse cardiovascular events in adults with established cardiovascular disease only and will implement the Wegovy clinical prior authorization for clients enrolled in Medicaid fee-for-service. www. J Clin Sleep Med. 5 mg / 0. GPI: 6125207000D530 In the US, semaglutide is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes; [13][14] and to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease. Impact on Billing and Reimbursement Processes The J Code for semaglutide plays a significant role in Clinical Policy: Semaglutide (Wegovy) Reference Number: CP. These HCPCS are excluded from Medicare Part B when provided in an outpatient setting. What Z code combinations need to be used? The med list you provided does not include insulin, so you wouldn't use Z79. Understanding its importance helps in appreciating how it impacts billing, patient access, and the broader healthcare system. Comprehensive guide on ICD-10 coding for Wegovy, including documentation requirements and billing considerations for obesity management. Order Wegovy® Semaglutide injection pens by Novo Nordisk Pharma for effective treatment and management of health conditions. 25 Line of Business: Commercial Nov 30, 2022 · Complete details for NDC 00169-4525-14 WEGOVY 0. B. The NDC Packaged Code 0169-4525-14 is assigned to a package of 4 syringe, plastic in 1 carton / . Jul 18, 2025 · Explore the benefits and risks of Wegovy, and get essential insights to make informed decisions about this weight management medication. Does the patient have a previous Blue Cross NC approval and has taken the requested medication for Doc prescribed me Wegovy to replace the Metformin and help me lose the next 30 lb. that may help adults and children aged 12 years and Aug 1, 2025 · Infusion/Injection Medication Food and Drug Administration approval is a prerequisite, but not all FDA-approved drugs are covered by TRICARE. Of note, this policy targets Saxenda, Wegovy, and Zepbound; other glucagon-like peptide-1 agonists which do not carry an FDA-approved indication for weight loss are not targeted in this policy. The Rybelsus® tablet brand demonstrates efficacy in improving glycemic control in patients with Nov 30, 2022 · Complete details for NDC 00169-4524-14 WEGOVY 2. Updated Sep 2025. See Home Infusion Therapy for information on medication coverage for self-injection and Supporting tables: a collection of information associated with the steps within the criteria (diagnosis codes, procedure codes, and therapy codes); provided when applicable References: clinical publications and sources relevant to this clinical criteria Note: Click the hyperlink to navigate directly to that section. Learn about clinical trial results for chronic weight management with Wegovy®. Wegovy for cardiovascular risk reduction in obesity or overweight We may cover Wegovy ® (semaglutide) to reduce the risk of major adverse cardiovascular events [MACE] (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) when all of the following criteria are met: Wegovy®. Oct 12, 2022 · Scenario: Patient has E11. 75 mL pre-filled pen-injector and is used for Weight Loss (Obesity/Overweight), Cardiovascular Risk Reduction, and Nonalcoholic Steatohepatitis. Medicare Part D may cover Wegovy for specific medical purposes, such as: Treatment of diabetes and prevention of cardiovascular death, heart attack, and stroke. [13] In the US semaglutide (Wegovy) is indicated, in combination with a reduced calorie diet and increased physical New Engl J Med. Discover the Aetna difference. jqry klaslvol vajuq ccjj kweacbi whh srthitv yksoad btnhp qmqes