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California Medicaid · Liver Disease (MASH)

California Medicaid coverage for Wegovy (Liver Disease (MASH))

Medicaid

Covered with requirements

What you need to qualify

  • Diagnosis documented with a code (K76.0, K75.8)
  • Confirmed MASH diagnosis

Qualification pathways

You can qualify through any one of these.

MASH without cirrhosis — no PA required with correct diagnosis code

All of:

  • Noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) diagnosis
  • Claim submitted with ICD-10-CM diagnosis code K76.0 and/or K75.8

Documentation to bring

  • ICD-10-CM diagnosis code K76.0 (Fatty (change of) liver, not elsewhere classified) and/or K75.8 (Other specified inflammatory liver diseases) submitted on claim

Not covered when

  • Cirrhotic MASH not addressed; document specifies noncirrhotic MASH only

Policy note: Effective April 1, 2026. No PA required when claim is submitted with the appropriate ICD-10-CM diagnosis code (K76.0 and/or K75.8). Claims without the appropriate code will deny with Reject Code 80. Document does not specify detailed clinical criteria (fibrosis stage, confirmation methods, etc.) beyond the diagnosis code requirement.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12_A_GLP-1_Coverage_Considerations.pdf

All Wegovy policies under California Medicaid · Check your card