Many patients who have inadequate or no insurance coverage for weight loss . 3 Blue Distinction Centers for Bariatric Surgery | Program Selection Criteria Cost Nationally consistent and objective approach for selecting BDC+ was used to address market and consumer demand for cost savings and affordable healthcare. At Highmark Blue Cross Blue Shield of Western New York, we've built our legacy around empowering our communities and helping you be your very best you. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All MPFS Fee Schedules calculated using CF of $36.0896 effective January 2020. However, an exclusion of weight loss surgery from your BCBS plan should not discourage you from exploring various low cost self-pay options. Open a PDF. No guarantee can be made of the accuracy of this information which was compiled from public sources. Abdominoplasty, Panniculectomy and Lipectomy . They address common medical situations. Central, Eastern and Northeastern Regions: 1-866-731-8080. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its . Coverage for services may vary for individual members based on the terms of their specific benefit plan and the specific facts of a particular situation. Gene Expression Profile Testing and Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer. 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: The Blue . He is an advanced laparoscopic surgeon and a leader in bariatric surgery. QHP Small Group Actual Policy Documents; . The Summary of Benefits and Coverage (SBC) document will help you choose a health . Coverage Policy . Internal Medical Policy Committee 11-23-2021 Revision added the length of time required for psychological evaluation to have documented prior to surgery . The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. licensees of the Blue Cross and Blue Shield Association. Airway Clearance Devices Oscillatory Devices (e.g., High frequency Chest Wall Compression, Flutter valve, Intrapulmonary Percussive Ventilator), Mechanical Percussors and Assisted Cough and . You can review our medical policies online any time. Medical Policies. Bariatric Surgery Billed With Hiatal Hernia Repair Bariatric Surgery Billed With Hiatal Hernia Repair; . Artificial Pancreas Device Systems. CIGNA said bariatric surgery coverage is an option available under Cigna's group medical plans, and clients can choose to include it. Need Help? Blue Distinction Centers are nationally designated healthcare facilities that show a commitment to . Dr. Chad Carlton is a board certified, fellowship trained bariatric surgeon. Exceptions to the age requirement can be made for patients under 18 years old if a . Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management. The online Medical Policy Reference Manual contains approved medical policies and operating procedures for all products offered by CareFirst. See answer (1) Best Answer. Bariatric Surgery; Cardiac Care; Cellular Immunotherapy; Fertility Care; Gene Therapy; . 800 Lanidex Plaza, Suite 100 Parsippany, NJ 07054 Office Phone: (973) 437-8700 Fax: 973-437-8787 • If individual has not had bariatric surgery, the member must have maintained a stable . Gender Affirmation Surgery. Independent licensees of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer. 2020-2021 Benefit Guide Effective July 1, 2020 . Weight loss surgery is an effective treatment for morbid obesity. January 29, 2021. Coverage for bariatric surgery or revision of a bariatric surgery procedure varies across plans and may be governed by state mandates. Community Blue Medicare PPO is a Medicare Advantage Preferred-Provider Organization plan that gives you coverage for every need— health, prescription drugs, routine dental, vision, hearing, and preventive care. Artificial Intervertebral Disc: Lumbar Spine. Procedures and General Guidelines Policies, Procedures and General Guidelines; . Gene Expression Profiling for Cutaneous Melanoma. Our medical policies include evidence-based treatment guidelines. In 2013, an estimated 179,000 bariatric surgeries were to be performed in the United States (Ponce, 2014). You can also view the retired medical policies . 2020-2021 Benefit Guide Effective July 1, 2020 . Each individual's unique clinical circumstances may be considered in light of current scientific literature. Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies. Medicare Advantage HMO: 1-866-517-8585. The increased number of ATTN: PROVIDERS REQUESTING AUTHORIZATION FOR BARIATRIC, CARDIAC, OR LAPAROSCOPIC PROCEDURES. Some hospital admissions require plan approval and will be reviewed for medical necessity. Highmark retains the right to review and update its medical policy guidelines at its sole discretion. If a patient is less than 18 years of age, a letter . The purpose of a Coverage Policy is to inform members and their physicians why certain medical procedures may or may not be covered under Arkansas Blue Cross and Blue Shield health plans. For Medicare Advantage Members, call: FreedomBlue PPO: 1-866-588-6967. . Policies are written to cover a given condition for the majority of people. Your needs all in one place. The SBC shows you how you and the would CPT Diagnosis of Morbid obesity, defined as a Body Mass Index (BMI) greater than 40 Or BMI 35 - 39.9 AND one of the following Hypertension Cardiovascular heart disease Dyslipidemia Refer to the customer's benefit plan document for coverage details. 2020 Cardiac Surgery: Is the Procedure Medicare Inpatient Only or not? On the other hand, 68% to 85% of MWL patients who are post‐bariatric surgery desire body contouring surgery to remove a panniculus (Constantine et al., 2014). High Tech Radiology including Cardiac Imaging and Radiation Oncology. Freestanding Ambulatory Surgery Center CPT CODE2 Description Nat Average Medicare . . . The medical director of Arkansas Blue Cross and Blue Shield has established specific coverage policies addressing certain medical procedures or technologies. If you have prescription drug coverage through Blue Cross and Blue Shield of Illinois, learning about your drug benefits can help you and your doctor get the most from your prescription drug coverage. The SBC shows you how you and the plan would Blue Shield of California Reproduction without authorization from 601 12th Street, Oakland, CA 94607 Blue Shield of California is prohibited Medical Policy An i ndependent m ember of the Blue Shield Association in the Pre 7.01.47 Bariatric Surgery Original Policy Date: April 14, 1970 Effective Date: May 1, 2022 Section: 7.0 Surgery Page: Page 1 . On the other hand, 68% to 85% of MWL patients who are post‐bariatric surgery desire body contouring surgery to remove a panniculus (Constantine et al., 2014). Meadville, PA - Meadville Medical Center (MMC) is proud to be recognized by Highmark Blue Cross Blue Shield (BCBS) with a Blue Distinction® Centers+ (BDC+) for Maternity Care designation, as part of the Blue Distinction Specialty Care program. Please keep in mind that: The policies aren't medical advice. Working with Dr. Sankar and PPG Health, Dr.Carlton . procedure unrelated to principal diagnosis with CC 5.7 $ 10,763 989 Nonextensive O.R. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Musculoskeletal policies including hip, knee, shoulder and spine related services. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use. Include medical records that support the need for inpatient care. INPATIENT FACILITY DRG Description* Average Length of Stay (Days)5 National Average DRG Payment5 Inpatient Facility 987 Non-extensive O.R. This program will be available on January 1, 2020. Association. That's why when you choose PPO BlueSM from Highmark Blue Cross Blue Shield Delaware, you get a plan that's simple to understand, easy to use, and easy to love. Discrimination is Against the Law These policies may change to stay up to date with current research. These guidelines address hundreds of medical issues, including diagnostic and therapeutic procedures, injectable drugs, and durable medical equipment. Laboratory Services. Health care plans are subject to terms of the benefit agreement. We incorporate input from the Massachusetts . Aqueous Shunts and Stents for Glaucoma. procedure unrelated to principal diagnosis with MCC 10.5 $20,881 988 Non-extensive O.R. If you must submit a telephonic request, call the appropriate phone number below to reach Medical Management & Policy: Western Region: 1-800-547-3627. Your Anthem Blue Cross insurance policy covers weight loss surgery unless it states specifically that it excludes it. NOTE: Information about the cost of this plan (called the premium) will be provided separately. Medical decisions relative to medical technologies are to be made strictly by members/patients in consultation with their health . Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. What to Expect During Bariatric Surgery Life After Weight Loss Surgery Surgery . Blue Distinction Centers are nationally designated health care facilities that show a . Acupuncture and Auricular Electrostimulation. All references to "Highmark" in this document are references to the Highmark company that is providing the member's health benefits or health . New mask policy at AHN facilities. Blue Cross Blue Shield Of Michigan Pre-Approval Requirements. Step 1: Determine whether prior authorization is needed. 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