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Examples include: The diagnosis must support medical necessity for the administered medication

Update: CMS revised MM13937, March 5, 2025, to add a paragraph about when mass immunizers may bill for hepatitis B claims using POS 60 and specialty code 73

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In general, to qualify for a tirzepatide prescription you will need: BMI of 30 or higher BMI of 27 or higher + at least one weight-related condition (high blood pressure, high cholesterol, type 2 diabetes, etc.) Your provider will also take into account your medical history, prior weight-loss attempts, and family history to help you find the best weight-loss treatment for your