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In the STEP-1 trial of 1,961 adults (Wilding and colleagues, Once-Weekly Semaglutide in Adults with Overweight or Obesity, New England Journal of Medicine, 2021), participants on semaglutide 2.4 mg lost an average of 14.9 percent of their body weight at 68 weeks, compared to 2.4 percent on placebo

Administration Codes: CPT 96372 - Therapeutic/prophylactic/diagnostic injection, subcutaneous or intramuscular (in-office administration) Modifier 59/XS - For additional separate injections on same date Modifier 25 - On E/M code when separate E/M service performed same day as injection Drug Codes (HCPCS): J3490 - Unclassified drugs (primary code for tirzepatide in physician office) C9399 - Unclassified drugs or biologicals (hospital outpatient setting) J3590 - Unclassified biologics (alternative, less commonly used) J3420 - Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg (when B12 billed separately) Diabetes Diagnosis Codes (Mounjaro): E11.65 - Type 2 diabetes with hyperglycemia (strongest for medical necessity) E11.9 - Type 2 diabetes without complications E11.21 - Type 2 diabetes with diabetic nephropathy E11.40 - Type 2 diabetes with diabetic neuropathy Z79.85 - Long-term (current) use of injectable non-insulin antidiabetic drugs Obesity Diagnosis Codes (Zepbound): E66.01 - Morbid (severe) obesity due to excess calories E66.09 - Other obesity due to excess calories E66.3 - Overweight Z68.30-Z68.45 - BMI codes (required supplemental codes) Common Comorbidity Codes: I10 - Essential hypertension E78.5 - Hyperlipidemia, unspecified G47.33 - Obstructive sleep apnea K76.0 - Fatty liver, not elsewhere classified (NAFLD) M19.90 - Unspecified osteoarthritis E/M Codes: 99203-99205 - New patient office visits 99213-99215 - Established patient office visits G0447 - Face-to-face behavioral counseling for obesity, 15 min (Medicare) Counseling and Therapy Codes: 99401-99404 - Preventive medicine counseling 97802 - Medical nutrition therapy, initial assessment 97803 - Medical nutrition therapy, reassessment This reference table covers the vast majority of coding scenarios for tirzepatide