% Location: MO. Blue Distinction Centers for Bariatric Surgery | Blue Shield of CA Log In to the Shopping Cart, Need to Make a Payment? <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Greater than or equal to 18 years; or b. Representatives are available 24 hours a day, seven days a week. Do I Need To Attend? Log In to the Shopping Cart, Need to Make a Payment? PDF 2022 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus A Open and laparoscopic vertical banded Gastroplasty, Patients compliance with post-operative diet and exercise regimen. or 100 percent over ideal weight or a body mass index (BMI) of at least 40 or a BMI of 35 with comorbidities. A new Global Period will not apply to a procedure meeting these requirements and reported with modifier 78. 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. *GP( @ r UQ T9 Repeat or Revised Bariatric Surgical Procedures. m4:TY=6uhKy+\W5nx` G;o\c0Va H }'H1hbX50aG@$GP0~ 0 *GP( @ r UQ T9 Please contact BCBS of Michigan directly to find out if they offer coverage for a second procedure. Facilities designated as Blue Distinction and Blue . 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. 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 in patients with diabetes and body mass index less than 35 kg/m 2. *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 If the individual does not meet *GP( @ r UQ T9 1226 0 obj <>/Filter/FlateDecode/ID[<85F633C9C5D3CC438248A4BA5CE2CCC7>]/Index[1202 37]/Info 1201 0 R/Length 115/Prev 386164/Root 1203 0 R/Size 1239/Type/XRef/W[1 3 1]>>stream Bariatric surgery may be indicated for patients 18 to 60 years of age. website at www.calpers.ca.gov. Bariatric Journal does not provide medical advice, diagnosis, nor treatment. VII. stream Internal Medical Policy Committee 1-20-2022 Revision with coding updates; Internal Medical Policy Committee 11-29-2022 Coding update - post-op. 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). 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. endobj Target Fair Price: $12,250. 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. 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. We are on a mission to help educate millions the benefits of weight loss surgery. *GP( @ r UQ T9 PDF Medical Management of Obstructive Sleep Apnea Syndrome - Blue Cross and sVNH~}%;@9uKG*>etc2/KNvTS=TuV1i#R| Surgical repair to correct perioperative or late chronic complications of a bariatric procedure may be considered medically necessary when there is documentation of a surgical complication related to the perioperative or late chronic complications of a bariatric procedure. *GP( @ r UQ T9 %PDF-1.5 *GP( @ r UQ T9 Medical Policy - Highmark *GP( @ r UQ T9 *GP( @ r UQ T9 5 0 obj =-]U6>(-Is[i5}{u?B}X* Does Blue Cross Blue Shield Cover Weight Loss Surgery? endstream How to Avoid a Denial - Bariatric Surgery Source Blue Cross Blue Shield of Minnesota Medical Policy . (EGD) are considered an integral component of all bariatric procedures and are not eligible for separate payment when reported on the same day as the bariatric surgical procedure. Policies, Guidelines & Manuals. *GP( @ r UQ T9 Contact information for your Anthem BCBS is listed below. Bariatric Surgery | Blue Cross and Blue Shield of Illinois - BCBSIL Sitemap, Bariatric Surgery 101 Guide: Read This First. Gastric banding, Lap Banding and Realize Band Gastric banding involve fitting an adjustable silicone band around the upper part of the stomach where the band restricts the amount of food and caloric intake, consequently allowing patients to lose up to 45% of their weight. The individual's understanding of the procedure and ability to participate and comply with life-long follow-up and the life-style changes (e.g., changes in dietary habits, and beginning an exercise program) are necessary to the success of the procedure. "Dental necessity" or "dentally necessary" means or describes a dental service that a dental care provider, exercising prudent clinical judgment, would provide to a covered person for the purpose of evaluating, diagnosing or treating a dental illness . endobj Surgery: Gastric Bypass. If a conflict arises between a CPCP and 1 0 obj This is true only if youve had a previous adjustable gastric banding procedure that met all of the criteria laid out for that procedure. <> *GP( @ r UQ T9 Enteric fistula that does not close with bowel rest and nutritional support; Gastrogastric fistula associated with ulcers, gastroesophageal reflux disease (GERD) and weight gain; Disruption/anastomotic leakage of a suture/staple line; Band intolerance with obstructive symptoms (e.g. *GP( @ r UQ T9 bariatric surgery would be considered a component of and incidental to the primary . *GP( @ r UQ T9 Blue Cross Blue Shield of Louisiana HMO Bariatric Surgery *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 *GP( @ r UQ T9 8 0 obj *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 . Covered gastric restrictive or malabsorpive procedures must be performed in an approved facility with one of the following accreditations, https://www.facs.org/search/bariatric-surgery-centers. *GP( @ r UQ T9 Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. 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. 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. *GP( @ r UQ T9 Member meets one of the following BMI requirements and has been at that BMI for a minimum of 2 years: o BMI over 40 o BMI . <> National Range: $11,550 - $27,325+. Less than 18 years of age and has attained Tanner 4 or 5 pubertal . Individuals should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure. The Pouch Reset Losing Weight After Weight Regain, Expected Weight Loss From Gastric Sleeve Surgery Calculator, Recovery From Gastric Sleeve What To Expect From Day 1, Before And After Your Gastric Balloon [Complete Guide], 5 Ways to Prevent Stretching Your Stomach After Gastric Bypass. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Bariatric and Transplant care benefits are limited to services provided in a Blue Distinction Center (see pages 62 and 66 ). However, coverage and payment for these services depends on the type of provider submitting the claim, the procedure/service and diagnosis codes submitted, and the patient's contract with Blue Cross. Blue Cross PPO, Blue Cross-Blue Shield* and Cigna PPO. Log In to the Shopping Cart, Need to Make a Payment? comply with pre- and post-surgical requirements Note: . Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. [oH:kv=(@me_Wu C w/n7}3N$*hX|! *GP( @ r UQ T9 InterQual criteria is used to evaluate whether a medical procedure or equipment . *GP( @ r UQ T9 %%EOF *GP( @ r UQ T9 Gastric Sleeve Surgery. *GP( @ r UQ T9 Fellow, American Society for Metabolic and Bariatric Surgery; SJ Magazine "Top Docs" - 2014, 2015, 2016, 2019, 2020, 2021, 2022; South Jersey Magazine "Best Doctors . Morbid obesity is further defined as a condition of . As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. Conservative measures for weight reduction should include changes to the individual's dietary, medication, and exercise regimen; The individual must complete a multidisciplinary evaluation including medical, nutritional, and psychological evaluations. ANYONE endobj *GP( @ r UQ T9 Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. To obtain a copy of the health premium As a result, some centers require active participation in a formal weight reduction program that includes frequent documentation of weight, dietary regimen, and exercise. Open Gastric Bypass Surgery This procedure is rare and only performed under particular medical circumstances. 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. All rights . PDF Bariatric Surgery Selection Criteria - Blue Cross Blue Shield Association 1202 0 obj <> endobj *GP( @ r UQ T9 Bariatric Surgery Which Procedure Is Best? 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. 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. Bariatric Journal is the leading bariatric surgery resource site for patients. *GP( @ r UQ T9 Most PDF readers are a free download. 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. *GP( @ r UQ T9 We removed the limit on covered non-sibling donors for transplant services . Centers for Bariatric Surgery. Surgeon: James Stephen Scott. *GP( @ r UQ T9 2. endstream endobj 1203 0 obj <. This new site may be offered by a vendor or an independent third party. Directory of Blue Distinction Centers and . National Average: $19,450. Corporate Medical Policy Bariatric Surgery - Blue Cross NC Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Laparoscopic adjustable gastric banding is contraindicated for individuals aged 17 years or under. *GP( @ r UQ T9 SKYGEN USA administers dental services for Horizon NJ Health members. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Medical policies for providers | Wellmark endobj *GP( @ r UQ T9 BCBS New York Excellus Weight Loss Surgery Kaiser Permanente Covers Weight Loss Surgery. PDF 2022 Health Benefit Summary - CalPERS endobj PDF REIMBURSEMENT POLICY Weight Management Care - Blue Cross MN stream endstream endobj startxref hbbd```b`` "HE`Z09D|&&_IO`" H2nb3w Z'[A$)X}L?o F_ Bariatric Surgery | BCBSND *GP( @ r UQ T9 In addition, some sites may require you to agree to their terms of use and privacy policy. endstream endobj startxref Check with your employer to find out how much they contribute toward your premium. ALL @h23Begj!b4ZJ2}Y*bPc6d 5d 05dD/Br,Fsr#0Yi^kRsTCx aEt! 10 0 obj post-op. 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). Medical Policy #: 02.01.56 . 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. PDF FEP Blue Focus Prior Approval List - Premera Blue Cross Morbid obesity is defined as a body mass index (BMI) greater than 40 kg/m2 or a BMI greater than 35 kg/m2 with associated complications including, but not limited to, diabetes, hypertension, or obstructive sleep apnea. PDF Reimbursement Information - BCBSIL @Z":h4PFKF&-TMAyyRGyyRGyq5)tRZO!9YHBPV"el)5CS1`SI j)fhVP0,f!6A26`xaijA@kRsTB{3 rHV+aU1^f:(sJ#:T09I+*! Psychological Testing Form. Contact 866-773-2884 for authorization regarding treatment. Complications can include but are not limited to fistula, obstruction or disruption of a suture/staple line. PDF 7.01.516 Bariatric Surgery - Premera Blue Cross *GP( @ r UQ T9 The following bariatric procedures may be considered medically necessary for the surgical treatment of morbid obesity whenALLof the selection criteria are met. Please refer to the criteria listed below for genetic testing. endstream To find out which services are covered under your policy at any facility, please call the customer service number listed on your Blue Cross and Blue Shield of Illinois member ID card. Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association . Directory ofBlue Distinction Centers and Blue Distinction Centers+ for Bariatric Surgery, Program Selection Criteria For Bariatric Surgery. 2 years after the original weight loss surgery, weight loss is still less than 50% of pre-operative excess body weight and weight remains at least 30% of the patients ideal body weight, per BMI. 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. 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. %PDF-1.6 % *GP( @ r UQ T9 *GP( @ r UQ T9 Bariatric Surgery | Blue Cross and Blue Shield of Oklahoma - BCBSOK

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