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November 22, 2006
 
 
MEDICAID INFORMATION RELEASE #MA06-38
 
To:                  Physicians, Osteopathic Physicians, Hospitals and Anesthesiologists
 
From:              Leslie M. Clement, Administrator
                       Division of Medicaid
 
Subject:           Change in Medicaid Policy for Bariatric Surgeries
 
Effective immediately, Medicaid will only cover bariatric surgeries that are performed in a Medicare approved Bariatric Surgery Center (BSC) or Bariatric Surgery Center of Excellence (BSCE). A list of facilities approved by Medicare for bariatric surgery is available online from the Centers for Medicare and Medicaid Services (CMS) website at: http://www.cms.hhs.gov/MedicareApprovedFacilitie/
 
Prior Authorization is required for all bariatric surgeries as outlined in Information Release IR #MA04-57, Bariatric Surgery, Panniculectomy/ Abdominoplasty, available online at: http://www.healthandwelfare.idaho.gov/DesktopModules/ArticlesSortable/ArticlesSrtView.aspx?tabID=0&ItemID=1346&mid=10309. Prior authorization requests should be directed to Qualis Health at 800 783-9207.
 
Idaho Medicaid rules concerning bariatric surgery are found in sections 431-434 of Idaho Code IDAPA 16.03.09, Medicaid Basic Plan Benefits, available online at: http://adm.idaho.gov/adminrules/rules/idapa16/0309.pdf. As a reminder, Current Procedural Terminology (CPT) code 43770 - Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric bands - is not covered by Medicaid.
 
This information is in addendum to the following sections of the provider handbooks:
·        Section 2 – General Billing Information, Section 2.3.2 – Medicaid Prior Authorization
·        Section 3 – Physician/Osteopathic Guidelines, Section 3.2.5.1- Bariatric Surgery
·        Section 3 – Hospital Guidelines, Section 3.6.2.3- Obesity
 
If you have questions concerning this IR, please contact Frutoso Gonzalez at (208) 364-1833.
 
LMC/af