What diagnosis will cover semaglutide?
Asked by: Maurice Ortiz III | Last update: August 24, 2025Score: 4.8/5 (41 votes)
How do you get approved for semaglutide?
Generally, individuals with a body mass index (BMI) of 30 or higher or a BMI of 27 or higher with at least one weight-related health condition, such as type 2 diabetes, high blood pressure, or high cholesterol, may qualify for Semaglutide treatment.
What are the criteria for semaglutide?
The FDA recommends Wegovy for weight loss if you meet one of the following criteria: Have a body mass index (BMI) of 27kg/m2 or greater and at least one weight-related condition, such as high blood pressure, Type 2 diabetes or high cholesterol. Have a BMI of 30kg/m2 or greater.
What is an acceptable diagnosis for Ozempic?
Ozempic, which has become synonymous with weight loss medication, is FDA-approved only for treatment of Type 2 Diabetes Mellitus (T2DM). It's important for us to communicate this to our patients as there has been a great deal of misinformation on what is an FDA-approved drug for obesity.
What is the ICD 10 code for semaglutide?
The ICD-10 code used to identify semaglutide as the current long-term antihyperglycemic medication is Z79. 899.
Doctors explain how Wegovy and Ozempic work | 60 Minutes
What ICD-10 codes cover Ozempic?
Ozempic is an injectible non-insulin antidiabetic medication, so you could use Z79. 85.
Can you be prescribed semaglutide without diabetes?
Semaglutide is the generic drug name for Wegovy and Ozempic, which are the most recognized brands used for weight loss treatments. These have been approved as an injectable medication for weight loss in non-diabetic individuals with obesity.
What conditions qualify for Ozempic?
Patients looking to use Ozempic must have a BMI of 30 or higher to qualify for the use if they do not have diabetes, but patients with a BMI between 27 to 30 can also be eligible if they have another condition (comorbidities) such as hypertension, high cholesterol, sleep apnea or hormonal conditions that can impede the ...
Why is my insurance not approving Ozempic?
Most insurance companies will only cover Ozempic for its FDA-approved indication of treating type 2 diabetes. Some plans require additional criteria to be met, such as having tried other medications for diabetes first or having a certain severity of disease.
Who is a good candidate for semaglutide?
Deciding if semaglutide is right for you
To be a candidate, you must be overweight or obese with a body mass index (BMI) greater than 30. You're also a candidate if you have a BMI of 27-30 and another condition, like heart disease, type 2 diabetes, or high cholesterol.
How to get insurance to pay for semaglutide?
Prior authorization (PA) is required by some prescription insurance plans to cover this class of prescription products. The patient's health care provider will need to submit a form to the patient's insurance company to seek approval for the medication.
Who does not qualify for semaglutide for weight loss?
Individuals with a history of pancreatitis or a personal or family history of medullary thyroid carcinoma (MTC) should not use Semaglutide. Semaglutide is also not recommended for individuals with a history of severe gastrointestinal disease or gastroparesis, as it may exacerbate these conditions.
What makes you qualify for semaglutide?
To qualify for semaglutide for weight loss, you need to have a BMI of 30 or higher. Or a BMI of 27 or higher with at least one weight-related health condition, like high blood pressure or heart disease. But a healthcare provider can determine whether semaglutide is right for you.
How do I get semaglutide for $25 a month?
Save on Ozempic® (semaglutide) Injection
If you have commercial or private insurance, you may PAY AS LITTLE AS $25 for a 1-month, 2-month, or 3-month supply of Ozempic® for up to 48 months.
Will an endocrinologist prescribe semaglutide?
Any licensed healthcare provider can prescribe semaglutide, including your primary care physician, endocrinologist, and, yes, a plastic surgeon–anyone with an active medical license.
Can you really get Wegovy for $25?
Yes, you can really get Wegovy for $25 if you meet certain criteria. Offered by Novo Nordisk, the Wegovy Savings Card awards qualified individuals the opportunity to get the medication for $25 per month (i.e. 28-day supply).
Does Blue Cross Blue Shield cover Ozempic?
BCBS typically requires prior authorization for Ozempic. You can check if your specific plan does by reviewing your plan's drug formulary. If you see a “PA” next to Ozempic, that means prior authorization is required. It's worth noting that submitting the paperwork doesn't always result in approval.
How much is semaglutide without insurance?
Without insurance, the cost of semaglutide can range from $968.52 to $1,349.02 per month.
What diagnosis covers Ozempic?
Most insurance companies cover Ozempic when it's prescribed to treat type 2 diabetes, but not for weight-loss.
What to say to a doctor to get Ozempic?
Tell your provider why you're interested in Ozempic — a good doctor won't judge you or your desire to use a weight loss medication. They'll likely ask about your medical history, go over your eligibility, and consider anything that might make you a bad candidate for Ozempic.
What does your A1C need to be for Ozempic?
A majority of adults taking Ozempic® reached an A1C under 7% and maintained it. In 2 different studies, adults lowered A1C, on average, by: Ozempic®: 1.4% (0.5 mg) and 1.6% (1 mg) vs placebo: 0.1% Ozempic®: 1.9% (1 mg) and 2.1% (2 mg), taking 1 or 2 diabetes pills.
How fast can I lose 20 lbs on semaglutide?
How fast you can lose 20 lbs on semaglutide (Wegovy) depends on your starting weight and other factors. If you weigh 232 lbs at the start of Wegovy treatment, you can expect to lose 20 lbs in around 16-20 weeks (4-5 months).
Who Cannot use semaglutide?
Tell your doctor if you or anyone in your family has or has ever had MTC or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2; condition that causes tumors in more than one gland in the body). If so, your doctor will probably tell you not to use semaglutide injection.
What is the strongest weight loss prescription pill?
Some of the strongest weight loss pills available today include: Naltrexone/bupropion (brand name Contrave) Phentermine/topiramate (brand name Qsymia) Orlistat (brand names Xenical, Alli)