Blue Cross and Blue Shield of Texas BCBSTX Medical Policies are based on scientific and medical research. Patients must meet the Patient Selection Criteria described in this policy.
Bcbs Of Texas Criteria For Weight Loss Coverage
UnitedHealthcare Commercial Medical Policy Bariatric Surgery.
Bcbs texas bariatric surgery medical policy. Division of Health Care Service Corporation a Mutual Legal Reserve Company an Independent Licensee of the Blue Cross and Blue Shield Association Page 1 of 1 BARIATRIC SURGERY Bariatric Surgery Medical Policy SUR716003 Please complete all appropriate questions fully. Medical policies and clinical utilization management UM guidelines are two resources that help us determine if a procedure is medically necessary. Bariatric Policy Fed BCBS.
There are several factors that impact whether a service or procedure is covered under a members benefit plan. April 1 2021 Replaces. They are often used as guidelines for coverage determinations in health care benefit programs.
This page explains the coverage requirements plan types and covered procedures as well as how to appeal a denial. Current History Physical. In addition to the active and pending Medical Policies BCBSIL has included policies which are under development or being revised.
MEDICAL POLICY 701516 Bariatric Surgery BCBSA Ref. Over 750 facilities applied and were evaluated on objective transparent selection criteria with quality business and cost of care components. The Agency for Healthcare Research and Quality AHRQ conducted an evidence-based practice center systematic review protocol entitled.
Blue Cross Blue Shield of Texas BCBSTX covers weight loss surgery. Written by OC Staff March 1. Use the contact information at the bottom of this page to find out if your policy has a specific exclusion for weight loss surgery.
Ingested food through the intestinal tract. Considered for the Bariatric Surgery designation under this Program. These Medical Policies serve as guidelines for health care benefit coverage decisions which may vary according to the different products and benefit plans offered by BCBSIL.
However some policies do specifically exclude weight loss surgery. December 1 2020 Instructions for Use. BCBSTX MEDICAL POLICIES AND BCBSTX CLINICAL PAYMENT AND CODING POLICIES.
Comparative Effectiveness of Bariatric Surgery and Non-Surgical Therapy in Adults with Metabolic Conditions and Body Mass Index of 30 to 349 kgm 2 which examined the evidence regarding the comparative effectiveness of bariatric surgery versus conventional non-surgical. The HCSC Medical Policy Manual contains Medical Policies used by Health Care Service Corporation a Mutual Legal Reserve Company HCSC operating through its divisions Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of New Mexico Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas. Providers please refer to the single source preauthorization list.
Medical policies which are based on the most current research available at the time of policy development state whether a medical technology procedure drug or device is. 20138 Transesophageal Endoscopic Therapies for Gastroesophageal Reflux. Blue Cross Blue Shield of Texas covers 3 weight loss procedures including the Gastric Sleeve Gastric Bypass and Lap-Band assuming your policy includes bariatric surgery.
Some bariatric procedures may include both a restrictive and a malabsorptive component. Bariatric surgery should be performed in appropriately selectedindividuals 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. These documents are available to you as a.
Musculoskeletal policies including hip knee shoulder and spine related services. Regence Blue Cross Blue Shield covers 3 weight loss procedures including the Gastric Sleeve Gastric Bypass Lap-Band assuming your policy includes bariatric surgery. By OC Staff March 1 2017.
Vitamin Guidelines After Bariatric Surgery. They are often used as guidelines for coverage determinations in health care benefit programs. 1 Benefit design is determined independently by the local Blue Plan and is not a feature of any Blue Distinction program.
Bariatric surgery is performed for the treatment of morbid clinically severe obesity. This page explains the coverage requirements plan types and covered procedures as well as how to appeal a. Medical Policies Clinical UM Guidelines.
Morbid obesity is defined as a body mass index BMI greater than 40 kgm2 or 35 kgm2 with associated complications. You can also view the retired medical policies and out-of-area medical policies. Blue Cross Blue Shield of Texas Criteria for Insurance Coverage.
May 1 2021 Last Revised. Providers should be knowledgeable about BCBSIL Medical Policies. Copyright 2020 United HealthCare Services Inc.
This site complies with the HONcode standard for trustworthy health information. Suggested medical record documentation. 70147 RELATED MEDICAL POLICIES.
Bariatric Surgery Page 1 of 65 UnitedHealthcare Commercial Medical Policy Effective 12012020 Proprietary Information of UnitedHealthcare. Home Bariatric Policy Fed BCBS. The online Medical Policy Reference Manual contains approved medical policies and operating procedures for all products offered by CareFirst.
BCBSTX Medical Policies and BCBSTX Clinical Payment and Coding Policies Blue Cross and Blue Shield of Texas BCBSTX Medical Policies are based on scientific and medical research. BARIATRIC SURGERY IN ADOLESCENTS Bariatric surgery in adolescents may be considered MEDICALLY NECESSARY according to similar weight-based criteria used for adults but greater consideration should be given to psychosocial and informed consent issues. Specialty Injectable drugs may require preauthorization.
