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Amputation A diagnosis with ICD-10-CM code Z89.2*, Z89.6*, S78.011A, S98.011A, S78.012A, S98.012A, S78.019A, S98.019A, S78.021A, S98.021A, S78.022A, S98.022A, S78.029A, S98.029A, S78.111A, S98.111A, S78.112A, S98.112A, S78.119A, S98.119A, S78.121A, S98.121A, S78.122A, S98.122A, S78.129A, S98.129A, S78.911A, S98.131A, S78.912A, S98.132A, S78.919A, S98.139A, S78.921A, S98.141A, S78.922A, S98.142A, S78.929A, S98.149A, S88.011A, S98.211A, S88.012A, S98.212A, S88.019A, S98.219A, S88.021A, S98.221A, S88.022A, S98.222A, S88.029A, S98.229A, S88.111A, S98.311A, S88.112A, S98.312A, S88.119A, S98.319A, S88.121A, S98.321A, S88.122A, S98.322A, S88.129A, S98.329A, S88.911A, S98.911A, S88.912A, S98.912A, S88.919A, S98.919A, S88.921A, S98.921A, S88.922A, S98.922A, S88.929A, S98.929A or a procedure with ICD-10-PCS code 0Y6[23478CDFGHJ]* or 0X6[012389BCDF]* Pregnancy A diagnosis with ICD-10-CM code O*, a pregnancy episode, or a birth record Bariatric surgery A procedure with CPT code 43644, 43645, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43845, 43846, 43847, 43848, 43886, 43887, 43888, 43842, or 43843 Limitations We allow a patient to be included in each month, using their highest weight in that month

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Whether you want to use semaglutide for either blood sugar stabilization or weight loss, it's important to make a plan for all contingencies so you have the best outcomes possible

Mid-Atlantic (VA, MD, DC): Kaiser Mid-Atlantic requires prior authorization, including documented 5% weight loss in the prior 3 months for continuation authorization

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