Bariatric surgery services
Applies to:
All plans
Definition
The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch.
Medical policy
Overweight and obesity clinical practice guidelines
Bariatric surgery coverage
Weight-loss surgery may not be covered, especially by self-funded group plans and individual plans. Verify the member's coverage by using Member Inquiry to check the Additional benefits for the Certain surgeries benefit, or call the Provider Helpline.
Non-standard cost-sharing
If/when commercial employer group and MyPriority® individual plans cover certain surgeries, these surgeries may be covered at a different cost-sharing level than our standard benefit coverage levels.
To verify member cost sharing and coverage, use the Member Inquiry tool and look in the Additional benefits drop-down menu for Certain surgeries benefit information.
Bariatric surgery authorizations
Starting Oct. 31, 2022, we’ll require the pre-surgical evaluation to cover specific areas related to a member’s drug use habits to meet prior authorization requirements. See the medical policy for details and a sample survey.
- Participating providers: Use our online authorizations tool to go to GuidingCare.
- Non-participating providers: Use this Medical Authorization form.
Bariatric surgery billing
See the medical policy for codes that may apply and codes not covered.
Check eligibility & coverage
Authorization tools
In prism, you can request a new authorization or check an auth's status.