Obesity ICD-10 Codes for GLP-1 Prior Authorization (2026)

By the The RX Index editorial team — an independent comparison resource for GLP-1 telehealth providers. This guide is educational. It is not medical, coding, reimbursement, or legal advice. We may earn a commission from some provider links, but providers do not control our coding guidance, our sources, or our conclusions. Last verified: June 8, 2026.

Something probably went wrong to land you here — a pharmacy rejection, a denial letter, or your doctor's office asking, "What code should we use?" Here's the answer, fast.

The obesity ICD-10 codes for GLP-1 prior authorization are usually an E66 obesity code plus a Z68 BMI code — not a BMI code by itself. For an adult with documented obesity, the most specific codes are the obesity class codes: E66.811 (class 1), E66.812 (class 2), and E66.813 (class 3). Overweight requests usually start with E66.3 plus the documented weight-related condition. Many plans still accept the older E66.01 and E66.09, too.

But the code is only one piece of a five-part packet. The piece that matters most? The drug you're taking decides the code. Weight-loss drugs (Wegovy, Zepbound, Saxenda, Foundayo) use obesity codes. Diabetes drugs (Ozempic, Mounjaro, Rybelsus) do not — they need a type 2 diabetes code (E11). Put an obesity code on a diabetes drug and most plans deny it on the spot.

Quick answer: adult obesity codes for a GLP-1 prior authorization

One rule beats every shortcut: match the code to what the drug is approved to treat — not to why you personally want it. Everything below builds on that.

What obesity ICD-10 codes are used for GLP-1 prior authorization?

The short answer: Adult obesity GLP-1 requests usually use an E66 obesity code — most precisely E66.811, E66.812, or E66.813 (obesity class 1, 2, or 3) — paired with a Z68 BMI code. The older codes E66.01 (severe obesity) and E66.09 (other obesity) are still widely accepted by insurers. The parent code E66.0 is not billable by itself and will be rejected.

Most people walk in looking for the magic code. There isn't one. There's a code packet: a diagnosis code, a BMI code, the right drug pathway, your chart notes, and your plan's rules. Miss any piece and the whole thing can bounce.

The obesity codes (the E66 family)

A note many pages get wrong. The new class codes (E66.811/812/813) say only "class 1, 2, or 3." The BMI numbers are the medical definition of each class — they aren't written into the code. That's exactly why you also add a BMI (Z68) code. The obesity code says what you have. The BMI code says how much.

Old codes vs. new codes — which should you use? The CDC now recommends the newer class codes and tells providers to update away from E66.01, E66.09, E66.8, and E66.0. But plenty of insurers and drugmaker guides still list and accept E66.01 and E66.09. The honest answer: use the most specific code your chart supports and your plan accepts.

Can a BMI (Z68) code be used by itself?

The short answer: No. Under the FY2026 ICD-10-CM Official Guidelines, a BMI code (the Z68 family) is a secondary code only. It can never be the main reason for a visit, and it can only be used when a provider has documented a related diagnosis like obesity or overweight. A BMI code with no obesity diagnosis behind it is a classic cause of a "missing information" or "invalid diagnosis code" rejection.

Think of it this way. Your BMI is a measurement — like your blood pressure. A measurement isn't a diagnosis. The Z68 code records the number. The E66 code records the condition. They travel together.

One helpful detail: a nurse or dietitian can record your BMI, but the doctor (or your prescriber) has to document the obesity or overweight diagnosis for the code to hold up.

Before your prescriber hits "submit," can you answer these five?

Which obesity code matches my BMI?

The short answer: Adult BMI maps to the class codes like this — E66.811 for BMI 30 to under 35, E66.812 for BMI 35 to under 40, and E66.813 for BMI 40 or higher. You then add the Z68 code for your exact number, such as Z68.32 for a BMI of 32 or Z68.41 for a BMI of 41.

The date matters as much as the number. A BMI with no recent date is one of the most common reasons a request stalls.

What about teens (ages 12–19)?

The short answer: Wegovy and Saxenda are FDA-approved for adolescents 12 and older with obesity, but kids and teens are not coded with the adult BMI numbers. A child's obesity is based on BMI-for-age percentile, so the request pairs the same obesity class code with a pediatric BMI code (Z68.54, Z68.55, or Z68.56).

Per the CDC's childhood obesity code update:

Why does the drug decide the code? (Wegovy vs. Ozempic, explained)

The short answer: Each GLP-1 is FDA-approved for a specific use, and the code has to match that use. Wegovy, Zepbound, Saxenda, and Foundayo are approved for weight management, so they use obesity codes (E66 + Z68). Ozempic, Mounjaro, and Rybelsus are approved for type 2 diabetes, so they use a diabetes code (E11). Putting an obesity code on a diabetes drug usually causes a denial, because the drug isn't approved to treat obesity.

Here's the catch: Ozempic and Wegovy contain the same active ingredient (semaglutide). Mounjaro and Zepbound contain the same active ingredient (tirzepatide). Same ingredient — but different FDA-approved products, with different labels and different approved uses. So they take different codes. Code by the approved use, not by the ingredient.

Weight-loss GLP-1s — obesity codes (E66 + Z68)

Diabetes GLP-1s — diabetes codes (E11)

That Z79.85 is a status code meaning "long-term use of an injectable non-insulin diabetes drug." It's a helper, not the main diagnosis — and it doesn't apply to the oral pill Rybelsus.

Want proof this isn't theory? California's Medicaid program (Medi-Cal) spells it out: as of January 1, 2026, Medi-Cal Rx no longer covers GLP-1s for weight loss, while diabetes GLP-1s stay restricted to type 2 diabetes. Submit one for the wrong reason and the claim returns a specific rejection — Reject Code 80, "Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria."

One honest note on compounded drugs. Compounded products containing semaglutide or tirzepatide are a different category. They are not FDA-approved finished drugs, are usually paid for out of pocket, and typically don't go through this brand-name prior-authorization process at all.

What documents have to match the code?

The short answer: The code is only as good as the chart behind it. A strong GLP-1 prior authorization usually needs a provider-documented diagnosis, a dated height/weight/BMI, your starting weight, any weight-related conditions, proof you've tried lifestyle changes (if your plan asks), and details specific to your drug. Missing or outdated paperwork is one of the most common reasons a request stalls — and it's the easiest to fix.

What counts as a weight-related condition (the BMI 27–29.9 path)?

The short answer: If your BMI is 27 to 29.9, most weight-loss-drug requests require at least one documented weight-related health condition. The ones plans most often accept are high blood pressure, type 2 diabetes, high cholesterol, and obstructive sleep apnea. The condition has to be coded in your chart — not just mentioned in conversation.

What's different for Zepbound and sleep apnea?

The short answer: Zepbound has a separate FDA-approved use — moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity. For that pathway, the main code is G47.33 (obstructive sleep apnea), with an obesity code added. Zepbound's OSA studies enrolled adults with obesity (BMI 30 or higher) and moderate-to-severe OSA, commonly defined as an AHI of 15 or higher.

Why does this matter? Because it can unlock coverage that "weight loss" can't — especially on Medicare. When sleep apnea is the documented reason, the request isn't a weight-loss request anymore. It's a sleep apnea request that happens to use a GLP-1. See more in our guide on Zepbound coverage for sleep apnea.

For this pathway, your prescriber typically documents the sleep-study or home-test result (your AHI and severity), the OSA diagnosis (G47.33), your weight and BMI, and your CPAP or other therapy history if the plan asks.

What's different for Wegovy and heart health?

The short answer: Wegovy is FDA-approved to lower the risk of major heart events (like heart attack and stroke) in adults who have known heart disease plus obesity or overweight. That's a separate argument from "weight loss," but the chart still has to document real, established heart disease — not just risk factors.

This pathway exists because of a large trial showing semaglutide cut heart events in people with established cardiovascular disease and excess weight. So if a plan excludes "weight-loss drugs" but covers heart medications, the heart-risk use can sometimes get through where weight loss wouldn't.

Two more Wegovy doors worth knowing: it's also approved for adolescents 12 and up with obesity, and — as of August 2025 — for adults with noncirrhotic MASH (a liver disease) with moderate-to-advanced liver fibrosis. Each of those is coded with its own diagnosis, not a weight-loss code.

What about Medicare and Medicaid?

The short answer: Standard Medicare Part D still does not cover GLP-1s prescribed only for weight loss. But starting July 1, 2026, a new program called the Medicare GLP-1 Bridge gives eligible Part D members access to certain GLP-1s for weight management at a $50 copay. Diabetes, Zepbound for sleep apnea, and Wegovy for heart-risk or MASH are already covered through regular Part D. Medicaid rules vary by state.

The Medicare Bridge has its own rules. It's only for weight management, and a beneficiary must meet clinical criteria: age 18+ with a BMI of 35 or higher; or BMI 30+ with a qualifying condition like heart failure with preserved ejection fraction, uncontrolled high blood pressure, or chronic kidney disease (stage 3a+); or BMI 27+ with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease. CMS says requests won't be accepted before July 1, 2026. If you're on Medicare, Medicaid, or TRICARE, a private telehealth coverage-checker is built for commercial insurance, not government plans. Learn more: Medicare GLP-1 Bridge: does your $50 copay count toward your Part D cap?

Why do GLP-1 prior authorizations get denied even when the code looks right?

The short answer: A correct BMI and a clean code still don't guarantee a "yes." Common reasons include the wrong code for the drug, a BMI that isn't documented with a recent date, a condition that wasn't coded, no record that you tried a cheaper drug first ("step therapy"), or a plan that simply excludes weight-loss drugs. Match the words on your denial letter to the fix below.

What this looks like in real life

This isn't hypothetical. In one public MassHealth appeal decision (Appeal No. 2301586), a provider prescribed Ozempic to treat "weight gain," with no diabetes diagnosis on the request. The denial was upheld — because that program doesn't pay for drugs used to treat obesity. The decision even points to the fix: if the patient does have a documented diabetes diagnosis, the prescriber should use the diabetes pathway instead. Same drug. Different code. Different outcome.

We use a real, public, citable case here on purpose, instead of a marketing testimonial.

What should go in a GLP-1 appeal or resubmission?

The short answer: Start with the denial letter — the exact reason decides what you send. A strong appeal or resubmission attaches the missing piece, addresses the stated reason head-on, and is filed before your plan's deadline (often 180 days for an internal appeal).

A clean resubmission or appeal packet usually includes:

• The denial letter and the original prior-authorization request, side by side.
• The specific item the plan said was missing — most often a dated height/weight/BMI, a coded comorbidity, or proof you tried a lower-cost drug.
• A letter of medical necessity from your prescriber that ties your diagnosis, BMI, and history to the plan's own criteria.
• Lab results that back up your conditions (blood sugar, cholesterol, etc.).
• For a peer-to-peer review, your prescriber talks directly with the plan's medical director — useful for borderline cases.

If your first internal appeal is denied, most plans must offer a second-level review and, after that, an independent external review. Your final denial letter explains how to request it. The whole point: don't just resend the same packet — fix the exact gap the letter named.

What does renewal (reauthorization) require?

The short answer: Renewal is a different test than your first approval. Many plans want proof the drug is working — most commonly, that you've lost at least 5% of your starting body weight — plus your current weight, your dose, and proof you're still doing the lifestyle work. Many initial approvals last only six months.

Here's a trap that catches a lot of people: you can get denied at renewal because the drug worked. You lost weight, your BMI dropped, and now the plan says you don't meet the BMI rule anymore. The fix is documentation, not panic.

The lesson: keep your starting numbers. A lower BMI today should be evidence the treatment is succeeding — not a reason to lose coverage.

What if your plan excludes weight-loss drugs entirely?

The short answer: If your plan excludes the whole category, a better obesity code won't help — the code isn't the problem, the plan design is. Your real options are to see whether another approved use applies to you (sleep apnea, heart-risk, MASH, or diabetes), file an exception or appeal, or look at cash-pay and other routes.

This is happening more, not less. Reuters reported on June 2, 2026 that Cigna would stop covering GLP-1 weight-loss drugs (including Wegovy and Zepbound) for its own employee health plan, effective July 1, 2026, while keeping coverage for diabetes use.

If you hit this wall, here's how to think about it:

• Is it a true exclusion, or just a denial? Read the letter. "Benefit exclusion" means the category isn't covered. That's different from "not medically necessary."
• Does another approved use fit you? If you genuinely have sleep apnea, established heart disease, MASH, or diabetes, that's a different — and sometimes covered — door.
• Cash-pay is more realistic than it used to be. See our guide on GLP-1 cost without insurance.

What should you say to your doctor and your insurer?

The short answer: Don't tell your doctor which code to use — that can backfire, and it's their call. Instead, ask whether your chart supports the diagnosis, BMI, condition, and pathway your plan needs. Bring specifics. Asking good questions gets you further than demanding a code.

Say this to your prescriber:

"Can we make sure my GLP-1 prior authorization includes the obesity diagnosis from my chart, my current height/weight/BMI with today's date, the matching BMI (Z68) code, any weight-related conditions I have, and whatever documentation my plan requires — before it gets submitted?"

If you've read up on the codes, ask it like this (ask, don't instruct):

"I read that the newer adult obesity codes are E66.811, E66.812, and E66.813, with a Z68 BMI code. Does one of those match what's documented for me — or does my plan need a different supported code?"

Say this to your insurer (the number's on your card):

"Does my plan cover this medication for weight management, sleep apnea, heart-risk reduction, MASH, or type 2 diabetes? Does it require prior authorization, step therapy, a specific BMI, a documented condition, or proof of weight loss to renew?"

That last question alone can save you weeks.

What if you don't have a prescriber — or yours won't help with the paperwork?

The short answer: You can't file a prior authorization yourself; a prescriber does it. If you don't have one, or your current office won't do the paperwork, telehealth weight-management providers can prescribe an FDA-approved GLP-1 and handle the prior-authorization submission for you. The codes on this page are what they'll use.

If your hold-up is getting the request submitted right, and you have commercial or employer insurance (or you're ready to pay cash), Ro is the option we'd point you to first here. Its free GLP-1 Insurance Coverage Checker (sponsored affiliate link, opens in a new tab) calls your insurance company on your behalf and emails you a personalized report. Here's what we verified on its pricing page (June 8, 2026):

The honest trade-off. Ro isn't free, and it isn't the cheapest path if all you want is the lowest possible cash price. But because Ro focuses on FDA-approved brand-name drugs and does the insurance and prior-auth legwork for you, it's the better fit when your real goal is getting a brand-name GLP-1 covered. If price is your only concern, our cost-without-insurance guide is the better starting point. And if you're on Medicare, Medicaid, or TRICARE, a private concierge can't coordinate your government coverage.

How we built this guide

We pulled from official coding sources, the FDA-approved uses, the drugmakers' own prior-authorization guides, public payer policies, and a real Medicaid appeal decision. We used patient forums only to understand how people describe the problem — never as proof for a medical, coding, or coverage claim.

The RX Index is an independent comparison resource for GLP-1 telehealth providers. We don't put a fake "medically reviewed by" stamp on our work, and we don't invent authors. We tell you what we checked and when, and we point you to the original sources so you can check too.

Frequently asked questions

What is the ICD-10 code for obesity for a weight-loss medication?

The most precise adult codes are the obesity class codes E66.811 (class 1), E66.812 (class 2), and E66.813 (class 3), each paired with a Z68 BMI code. The older E66.01 and E66.09 are still widely accepted. E66.9 (unspecified) works when details are unknown, but a specific code is better. E66.0 alone is a non-billable category header — do not submit it by itself.

What ICD-10 code is used for a Wegovy prior authorization?

An obesity code (E66) plus a Z68 BMI code, and a weight-related condition code if your BMI is 27-29.9. If Wegovy is being used for heart-risk reduction or for MASH (a liver disease), the relevant heart or liver diagnosis is coded instead of a weight-loss code.

What code is used for Ozempic or Mounjaro?

A type 2 diabetes code — E11.9 or a more specific E11 — often with Z79.85 for long-term use. An obesity code usually triggers a denial because these drugs are FDA-approved for diabetes, not obesity.

Can I use a BMI (Z68) code by itself?

No. Under the FY2026 ICD-10-CM Official Guidelines, BMI codes are secondary-only and require a provider-documented diagnosis such as obesity or overweight. A BMI code with no diagnosis behind it gets rejected.

Why was I denied even though my BMI qualifies?

Common reasons are the wrong code for the drug, a BMI not documented with a recent date, a condition that was not coded, no step-therapy record, or a plan that excludes weight-loss drugs. Match your denial letter to the right fix — each denial reason has a specific correction.

What is the obesity class code (E66.811/E66.812/E66.813)?

These are newer codes effective October 1, 2024 for obesity class 1 (BMI 30 to under 35), class 2 (BMI 35 to under 40), and class 3 (BMI 40 or higher). The code itself does not include the BMI number — that is why you also add a Z68 BMI code.

Does Medicare cover GLP-1s for weight loss?

Standard Part D does not (it is barred by law). But the Medicare GLP-1 Bridge covers certain GLP-1s for weight management at a $50 copay from July 1, 2026 to December 31, 2027. Medicare also covers GLP-1s for diabetes, and can cover Zepbound for sleep apnea or Wegovy for heart-risk reduction through regular Part D.

Can I use a diabetes code to get a weight-loss drug covered?

Only if you actually have a documented diabetes diagnosis. Coding a condition you do not have is fraud and can cost you your coverage. If you do not have diabetes, use the correct weight-loss pathway or another approved use instead.

Do compounded semaglutide or tirzepatide use these codes?

Usually not. Compounded versions are typically paid out of pocket and do not go through this brand-name prior-authorization process. They are a separate category from the FDA-approved brand drugs covered here.

Should I tell my doctor which code to use?

No. Bring the code family and the documentation checklist, then ask whether it matches your medical record. Your prescriber and their coder choose the final code — that is their responsibility.