endobj Forms | Providers | BlueCare Tennessee - BCBST Blue Cross and Blue Shield of Texas, a Division 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). (The individual has attained Tanner 4 pubertal development and final or near-final adult height (e.g., 95 % or greater) of adult stature); The individual is morbidly obese defined as a BMI greater than 50 kg/m2 or severely obese defined as a BMI greater than 40 kg/m2 with. The BDC for Bariatric Surgery program evaluates facilities with bariatric surgery programs that treat adult patients 18 years or older, in Comprehensive Center (with or without an on- site ICU) and Ambulatory Surgery Center (ASC) settings. Substantially impaired quality of life or activities of daily living; Moderate to severe OSA (apnea-hypopnea index greater than 15); Individuals must have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. BCBS of Texas Criteria for Weight Loss United Healthcares Criteria For Weight Loss Surgery Coverage, Medicares Criteria For Weight Loss Surgery Coverage. *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. *GP( @ r UQ T9 Request an Appointment. <> 2022 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option Section 5. <> Torrance Bariatric Institute provides expert weight loss procedures for patients looking for bariatric surgery in Torrance and surrounding areas. endstream These include but are not limited to: 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); Endoscopic procedures including but not limited to; StomaphyX device or restorative obesity surgery (ROSE) procedure; Gastrointestinal Liners (e.g., the EndoBarrier); Biliopancreatic bypass (the Scopinaro procedure) or laparoscopic; Vagal nerve blocking (VBLOC) therapy (neuromodulation non-metabolic), also known as the Maestro implant or Maestro rechargeable system; Single anastomosis duodenal-ileal bypass with Sleeve Gastrectomy (SIPS or SADI), Changed Title from Obesity to Bariatric Surgery, Sleeve gastrectomy is an eligible procedure as a first stage of a two-stage procedure. *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 If the individual does not meet when If a patient is less than 18 years of age, a letter . *GP( @ r UQ T9 Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies. BCBS New York Excellus Weight Loss Surgery Kaiser Permanente Covers Weight Loss Surgery. A new Global Period will not apply to a procedure meeting these requirements and reported with modifier 78. Bariatric Surgery for Obesity - UChicago Medicine 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. Less than 18 years of age and has attained Tanner 4 or 5 pubertal . To view this file, you may need to install a PDF reader program. *GP( @ r UQ T9 If the procedure youd like to have is not listed on the approved list, it is likely not covered. *GP( @ r UQ T9 Check here bluecross blueshield fed blue bariatric official portal step by step. Information regarding coverage of a second weight loss surgery is not available. For high BMI individuals in whom the duodenal switch may be difficult, it is reasonable to do a sleeve gastrectomy as the first stage of an intended two-stage duodenal switch. Effective May 01, 2023. PDF 2022 Bariatric Surgery Individual outcomes may vary. 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. 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. National Average: $19,450. *GP( @ r UQ T9 Medical Policy Update is a monthly newsletter for the health care providers who participate in our networks and submit claims to Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) using the appropriate HIPAA transactions or claim forms as required by Highmark BCBSWNY.This publication focuses only on medical policy and claims administration updates, including coding . *GP( @ r UQ T9 Revisions are covered if there is documentation of a failure secondary to a surgical complication. If the individual does not meetALLof the selection criteria for bariatric surgery, the procedure will be denied as not medically necessary. stream Active Participation and Documentation of non-surgical methods of weight loss. 6 0 obj *GP( @ r UQ T9 *GP( @ r UQ T9 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. %%EOF The Horizon Info Submission Template for Practitioners is another possible you can use to makes updates to your purveyor data in our systems. *GP( @ r UQ T9 *GP( @ r UQ T9 Skip to content. Morbid obesity is defined as a condition of consistent and uncontrollable weight gain that is characterized by. Read information on bariatric procedures, guides, find a surgeon and more. National Range: $11,550 - $27,325+. *GP( @ r UQ T9 [oH:kv=(@me_Wu C w/n7}3N$*hX|! 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. One option is Adobe Reader which has a built-in reader. 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. The criteria for selection to the Blue Distinction and Blue Distinction Centers+ for Bariatric Surgery program were developed with input from physician experts and medical organizations and include a comprehensive evaluation of structure, process and outcome measures. 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. and x Before calling make sure you see our questions to ask before calling your insurance company. bariatric surgery would be considered a component of and incidental to the primary .
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