Clinical Coverage Policy, A-15, Surgery for Clinically Severe or Morbid Obesity is amended with an effective date of Nov. 1, 2022.
The following updates in this policy are:
- Medicaid shall require a bariatric facility to achieve accreditation and demonstrate the ongoing compliance with the requirements of the accreditation by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
- The facility’s documentation of their Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) must be submitted with each prior approval request. Providers have 365 days, until Nov. 1, 2023, until submission of proof of accreditation is required for each prior approval.
- There will be no coverage for a bariatric surgical procedure for a beneficiary with a Body Mass Index (BMI) less than 35kg/m2
Providers are encouraged to review 1A-15, Surgery for Clinically Severe or Morbid Obesity for a detailed overview of other general language and formatting updates.
Contact
NCTracks Call Center: 800-688-6696