Bariatric surgery services

Applies to:

Commercial group HMO, EPO, POS and PPO plans

Commercial individual MyPriority® plans

Priority Health Choice plans (Medicaid and Healthy Michigan Plan)

Priority Health Medicare 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.

Go to Member Inquiry

Non-standard cost-sharing

If/when commercial employer group and MyPriority® individual plans cover certain surgeries, these surgeries are covered at a different cost-sharing level than our standard benefit coverage levels.

To verify member cost sharing, use the Member Inquiry tool and look in the Additional benefits drop-down menu for Certain surgeries benefit information.

Bariatric surgery authorizations

Authorization is required:

For all patients, for all procedures.

Participating providers: Use the Auth Request tool to go to Clear Coverage™

Non-par providers: Use the Bariatric Surgery Prior Authorization Form.

Authorization is not required:

N/A

Bariatric surgery billing

See the medical policy for codes that may apply and codes not covered.