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;.SovgPmc0u Ut9p+o1)ddT,c2MXy`PO;V kFXn^n1=u C5UL|efWaXenAFKua{ %,U(>t~;xL*[lMfl/$"Rg: >ArMT+&9!-Aa(=Xj _i5j)tpJh$D':uZ;yz.1KLLF *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means Blue Cross Blue Shield of North Carolina NC 3,700,000 4/1/2021 link X X X Anthem Blue Cross Blue Shield GA 3,600,000 8/13/2020 link X X CareFirst Blue Cross Blue Shield DC, MD, northern VA 3,500,000 7/1/2020 link X X (6 consecutive months w/in past 2 years) Anthem Blue Cross Blue Shield OH 3,400,000 8/13/2020 link X X *GP( @ r UQ T9 Bariatric Surgery BCBSA Ref. 2. or 100 percent over ideal weight or a body mass index (BMI) of at least 40 or a BMI of 35 with comorbidities. Understanding Weight-Loss Surgery: Is it for you? % Blue Cross Requirements for Weight Loss Surgery Covered Diagnosis Codes for Procedure Codes: 43644, 43770, 43775, 43843, 43846, and S2083, Covered Diagnosis Codes for Procedure Code: 43845, Internal Medical Policy Committee 3-16-2020 Revision, Internal Medical Policy Committee 11-19-2020 Revision, Internal Medical Policy Committee 11-23-2021 Revision. Log In to the Shopping Cart, Need to Make a Payment? A psychological evaluation must be performed by a licensed mental health care professional, and the individual must be recommended for bariatric surgery. The panniculus hangs below the level of the pubis (which is documented in photographs); and One of the following: . <> *GP( @ r UQ T9 Height: 5 feet 6 inches. The Center of Excellence should be certified by the American College of Surgeons as a level 1 bariatric surgery center. endobj Psychological Testing Form. However, you may want to have your bariatric surgeons office contact BCBS of Michigan directly and ask about coverage for a procedure that isnt listed above. Horizon Data Submission Template - Horizon Blue Cross Blue Shield of 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night. Gastric Sleeve Surgery. *GP( @ r UQ T9 website at www.calpers.ca.gov. 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances). Bariatric Surgery Bariatric surgery is performed to treat morbid (clinically severe) obesity. %PDF-1.5 No. *GP( @ r UQ T9 One option is Adobe Reader which has a built-in reader. GQ^3>EtB0Pq*%`4)}S[]6 Va.sMnLdEcobqV}un s^-(w=f(o`?~~qC 7KPDBBERo>(^Bg,{8uWU tASR/a^_NX,vfUrOG(!YW_^H <> Bariatric surgery may be indicated for patients 18 to 60 years of age. *GP( @ r UQ T9 Repeat or Revised Bariatric Surgical Procedures. Blue Cross Blue Shield Association. This policy version was replaced October 31, 2022. . NOTICE: This policy contains information which is clinical in nature. PDF Legend - American Society for Metabolic & Bariatric Surgery If a patient is less than 18 years of age, a letter should be provided from a physician stating that surgery may prove risky if withheld for a later date. ; Accept Read More, Anthem BCBS Requirements for Weight Loss Surgery, Gastric Sleeve Surgery Will My Stomach Stretch, Vitamin Guidelines After Bariatric Surgery, Gastric Sleeve Surgery The Complete Guide, Recovery From Gastric Sleeve What To Expect, Recovery From Lap Band Surgery What To, Gastric Bypass Vs. Gastric Sleeve Surgery, Expected Weight Loss From Gastric Bypass Calculator, 5 Ways to Prevent Stretching Your Stomach After, How Much Will You Weigh After Surgery Calculator, Cost of Gastric Sleeve (Sleeve Gastrectomy) Surgery, Lap Band Compared to Gastric Bypass Surgery, Mini-Gastric Bypass The Good, Bad, And Ugly. *GP( @ r UQ T9 ALL *GP( @ r UQ T9 Gastric Sleeve Completed Tour; Gastric Sleeve Expecting Weights Loss, End; Average Cost of Gastric Sleeve Surgery; Abdominal Sleeve: After Surgery Results and Selling; Gastric Hose Surgery: Recovery Time; Gastric Sleeve Pre-Op Diet; Duodenal Sleeve Post-Op Diet Guide; Gastric Sleeve . Less than 18 years of age and has attained Tanner 4 or 5 pubertal . Morbid obesity is further defined as a condition of consistent and uncontrollable weight gain that is characterized by a weight which is at least 100 lbs. *GP( @ r UQ T9 9 0 obj States Where Insurance Is Required To Cover Bariatric Surgery Under the Affordable Care Acts Essential Health Benefits Benchmark Plans, 23 states require that all individual, family, and small group insurance plans cover . The site may also contain non-Medicare related information. What is a Weight Loss Seminar? Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. 4 0 obj In addition, some sites may require you to agree to their terms of use and privacy policy. Even when a policy covers weight loss surgery for qualifying patients, some situations may lead to a denial such as: You or your doctor can write a letter of appeal to the insurance company to appeal, you must, however, provide documentation for all the criteria listed in the policy as well as those from your previous communications with your insurance company about the surgery. . Coverage is typically only offered if you followed the post-operative guidelines, changed your lifestyle and sought help from your bariatric surgeon, dietitian and other resources. Full coverage for a weight loss surgery procedure will be provided to a patient with a Body Mass Index (BMI) over 40. Body Mass Index (BMI) of 40 or greater OR. We removed the limit on covered non-sibling donors for transplant services . In general, 20% to 30% above "ideal" bodyweight, according to standard life insurance tables, constitutes obesity. Our Philosophy; . endobj Effective January 01, 2023, Internal Medical Policy Committee 3-23-2023 Revision - To qualify for coverage of weight loss surgery, your policy must include coverage. Bariatric Surgery Which Procedure Is Best? PDF 2022 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus A For further inquiries, contact Blue Cross Blue Shield of Louisiana HMO through their official website https://www.bcbsla.com or call them using the numbers behind your ID card (1-800-495-2583) to get accurate costs on various medical procedures they might be providing cover for based on price and location. *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 <> Directory of Blue Distinction Centers and . Arch Surg 2009; 144(12):1150-5. *GP( @ r UQ T9 Clinical Guidelines - Horizon NJ Health Does Bcbs Cover Bariatric Surgery - SurgeryTalk.net If you have surgery, some private Medicare Supplement plans might cover some out-of-pocket costs not covered under Original Medicare pays, such as . *GP( @ r UQ T9 Before calling make sure you see our questions to ask before calling your insurance company. post-op. *GP( @ r UQ T9 Bariatric Surgery | BCBSND Provider Policies, Guidelines and Manuals | Anthem.com F(PP0B/_Y#T3RF(PP0B4NOCD bp The individual is morbidly obese and is at least 18 years of age. Blue Cross covers services for the treatment of obesity, weight management, eating disorders, nutrition and physical activity counseling. Do I Need To Attend? Homepage Arash Sh 2022-11-18T01:32:57-08:00. . patient education. Blue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery offer a full range of bariatric surgery care, including: These centers have lower complication rates and fewer readmissions. @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! Request Out of Network Benefits. The eligible bariatric surgical procedures listed above unless otherwise specified are covered for individuals under the age of 18 years when they meetALLof the following criteria: If the adolescent does not meetALLof the adolescent selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. According to Blue Cross/Blue Shield of California Medically Necessary. Pd-&mm@!U+V]]h)z'/6;]oB=u[_J^H\nt`Q[Lo{Kxcp=s}Fe?L&`mq8,!PvokA_EP%>O[ s{jSAx 6&mWwOoZLzwd\^d^77ojxmoF=+g^iKE*f{v+o'([~lr|Xj}h.]VF74;UBQ>Bw%}|LMWo/+wzW#9+O[0*9)/}b5FA@V:Kb6!eM_O$WBwg]5@uE Please refer to the criteria listed below for genetic testing. Contact 866-773-2884 for authorization regarding treatment. Bariatric Surgery | Blue Cross and Blue Shield of Oklahoma - BCBSOK of the adolescent selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. 3 0 obj 5 0 obj Forms | Providers | BlueCare Tennessee - BCBST *GP( @ r UQ T9 endobj What is a Weight Loss Seminar? of the selection criteria are met. *GP( @ r UQ T9 The eligible bariatric surgical procedures listed above unless otherwise specified may be considered medically necessary for individuals under the age of 18 years when they meet Is a Second Weight Loss Surgery Covered if Gastric Banding Didnt Work? *GP( @ r UQ T9 stream <> QHP Small Group Actual Policy Documents; . *GP( @ r UQ T9 Blue Cross of California is the trade name for Anthem BCBS so your criteria for weight loss surgery will be the same as it is here. <> Returning Shopper? Section 3. <> As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. . Based on our data, the target fair price for a laparoscopic hysterectomy is $12,250, whether you have health insurance or not. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. Bariatric surgery should be performed in appropriately selected individuals by surgeons who are adequately trained and experienced in the specific techniques used and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. F(wG((|1]) <>>> Morbid This is the medical billing code for gastric bypass surgery. when 0 *GP( @ r UQ T9 Any bariatric surgeon that accepts Blue Cross Blue Shield of Michigan will know where the surgery has to take place. Revisions are covered if there is documentation of a failure secondary to a surgical complication. Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? Check with your employer to find out how much they contribute toward your premium. Sometimes you will need to Read more *GP( @ r UQ T9 Oklahoma Medicare, health insurance renewal for individuals & families, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. This is true only if youve had a previous adjustable gastric banding procedure that met all of the criteria laid out for that procedure. Blue Distinction. Medicaids Criteria for Weight Loss Surgery Coverage. *GP( @ r UQ T9 *GP( @ r UQ T9 Provider Discharge Form. a BMI of 35 or greater with at least 2 comorbidities. The site may also contain non-Medicare related information. *GP( @ r UQ T9 In addition, some sites may require you to agree to their terms of use and privacy policy. 18 years of age (special consideration if under . outpatient follow-up. bariatric surgery would be considered a component of and incidental to the primary . Medicaids Criteria for Weight Loss Surgery Coverage. Individual outcomes may vary. This also applies to the Blue Care Network of Michigan. Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield . Blue Cross and Blue Shield's Federal Employee Program Benefit Plans Brochures and Forms Webpage . 11 0 obj Patients in Georgia who are insured through the State Health Benefit Plan will now have coverage for weight-loss surgery beginning in 2022. Do I Need To Attend? *GP( @ r UQ T9 Primary Care Physician's Letter. Revisions to the surgery are covered by Blue Cross Michigan. *GP( @ r UQ T9 endobj O 13 0 obj Last Review: December 2022 . 6Nale{Aq;7Qy=1(tg?fd``{ X'@``} QT` PDF 2023 Benefit Summary Book The Pouch Reset Losing Weight After Weight Regain, Expected Weight Loss From Gastric Sleeve Surgery Calculator, Recovery From Gastric Sleeve What To Expect From Day 1, Before And After Your Gastric Balloon [Complete Guide], 5 Ways to Prevent Stretching Your Stomach After Gastric Bypass. *GP( @ r UQ T9 Representatives are available 24 hours a day, seven days a week. Accept Read More, Blue Cross Blue Shield of Michigan Requirements for Weight Loss Surgery Approval, Gastric Sleeve Surgery Will My Stomach Stretch, Vitamin Guidelines After Bariatric Surgery, Gastric Sleeve Surgery The Complete Guide, Recovery From Gastric Sleeve What To Expect, Recovery From Lap Band Surgery What To, Gastric Bypass Vs. Gastric Sleeve Surgery, Expected Weight Loss From Gastric Bypass Calculator, 5 Ways to Prevent Stretching Your Stomach After, How Much Will You Weigh After Surgery Calculator, Cost of Gastric Sleeve (Sleeve Gastrectomy) Surgery, Lap Band Compared to Gastric Bypass Surgery, Mini-Gastric Bypass The Good, Bad, And Ugly. In order to be approved by Horizon Blue Cross Blue Shield of New Jersey for bariatric surgery in the United States, you must meet the following criteria: Be Age 18 of age or older. %PDF-1.6 % *GP( @ r UQ T9 Below, you'll learn what factors into the cost of . The individual's medical record documentation should indicate that all psychosocial issues have been identified and addressed; Psychological evaluation documentation must be within the last year; Attainment or near-attainment of physiologic/skeletal maturity at approximately, age 13 in girls and 15 for boys. of the following criteria is met: Individual postoperative noncompliance negates the efficacy of revision or conversion surgery. This does permit subsequent assessment of both the efficacy of the sleeve (to see whether the second stage is really needed), assessment of the compliance of the individual (to see whether the more complicated procedure is justified) or to examine the metabolic and nutritional effects of the sleeve (to see whether potential further metabolic derangements of the duodenal switch would make it unadvisable). View the medical and drug authorization tables to determine when to request an authorization. To contact Blue Cross Blue Shield of Alabama, you can either log into their official websitehttps://www.bcbsal.org/web/index.html, use the telephone numbers on the back of your BCBSA ID card or call 1-888-267-2955 for family and individual services. Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. Blue Cross Blue Shield of Minnesota Medical Policy Miscellaneous Bariatric Procedures - Wellmark *GP( @ r UQ T9 Bariatric surgery should be performed in appropriately selected individuals by surgeons who are adequately trained and experienced in the specific techniques used and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. A member of the Blue Distinction Centers for Bariatric Surgery; Biliopancreatic bypass with duodenal switch (or open procedure) for individuals with a BMI of 50 kg/m2 or greater; Roux-en-Y gastric bypass (RYGB) (laparoscopic or open procedure); Sleeve Gastrectomy (laparoscopic or open procedure). *GP( @ r UQ T9 Morbid obesity is defined as a condition of consistent and uncontrollable weight gain that is characterized by. One option is Adobe Reader which has a built-in reader. Repeat surgical procedures for revision or conversion to another surgical procedure may be considered medically necessary when the initial bariatric surgery was medically necessary (and the individual continues to meet all the medical necessity criteria for bariatric surgery);andwhenANYONEof the following criteria is met: Internal Medical Policy Committee 11-29-2022 Coding update - December 06, 2022, Fargo (Headquarters) Psychiatric Residential Treatment Request Form. Policies, Guidelines & Manuals. TEC . *GP( @ r UQ T9 Repeat procedures for repair, revision, or conversion to another surgical procedure following a gastric bypass or gastric restrictive procedure not meeting the criteria as indicated in this policy are considered not medically necessary. Anthem BCBS and revisions - Revision Weight Loss Surgery - BariatricPal endobj Yes, weight loss surgery must be done at a. *GP( @ r UQ T9 Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. endobj <> Copyright 2022 Bariatric Journal, All Rights Reserved. stream Gastric Banding including the Lap Band and Realize Band, Duodenal Switch also known as Biliopancreatic Diversion, Any other experimental weight loss procedure, The patient continues to meet all the medical necessity criteria for bariatric surgery, and, There must be documentation that the patient was compliant with the original post-operative dietary and exercise program, and. The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity whenALLof the selection criteria are met. Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. accredited by the metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, . The policy bulletins on this web site were developed to assist Highmark Blue Cross Blue Shield in administering standard plan benefits and do not constitute a description of plan benefits. Renew Illinois Individual, Family & Medicaid Health Insurance, Blue Cross Community MMAI (Medicare-Medicaid Plan), Illinois Health Plan Tiered Prescription Drug Lists, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. *GP( @ r UQ T9 If the individual does not meetALLof the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. 6 0 obj Blue Cross Michigan can be contacted here or at the customer service number provided on the back of your enrollee ID card. 16 0 obj Most PDF readers are a free download. This website uses cookies to improve your experience. Obesity is an increase in body weight beyond the limitation of skeletal and physical requirements, as a result of excessive accumulation of fat in the body. You can also locate a contact number and email address on their website after choosing your state. Typically, Blue Cross Blue Shield does offer coverage if your primary procedure does not produce the expected results. <> 0 Coronary artery disease. BCBS of Texas Criteria for Weight Loss United Healthcares Criteria For Weight Loss Surgery Coverage, Anthem BCBS Requirements for Weight Loss Surgery, Medicares Criteria For Weight Loss Surgery Coverage. It is at this point that an insurance verification coverage process is conducted as well as pre-operative testing. ALL bariatric surgery. *GP( @ r UQ T9 endobj *GP( @ r UQ T9 *GP( @ r UQ T9 BCBS of Michigan provides full coverage for bariatric procedures provided the patient meets the following requirements: The patient's age is between 18 and 60. (2009) Preoperative weight loss before bariatric surgery. hb``` cc`aX` r0(i``ZG!'f{ Does Blue Cross Blue Shield of Alabama (BCBS) cover bariatric surgery? *GP( @ r UQ T9 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 4 (401) 274-4848 WWW.BCBSRI.COM Long-Limb Gastric Bypass (le, >150 cm) (CPT code 43847 - Gastric restrictive procedure with Individual outcomes may vary. <> 4 0 obj Blue Cross and Blue Shield of Oklahoma, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). rvYWDgg!MxV Centers for Bariatric Surgery. IMPORTANT REMINDER .
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