Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 08/06/09

​To: Participating Physicians

Date: August 6, 2009

Re: Removal of Prior Approval for Surgeries for Morbid Obesity
 

Rulemaking regarding the department’s policies for surgeries for morbid obesity will be adopted on September 1, 2009.  This rulemaking sets forth the requirements that must be met in order for surgeries for morbid obesity to be eligible for reimbursement from HFS. 

Effective with dates of service September 1, 2009, and after, providers will no longer be required to request prior approval for surgeries for morbid obesity.  Payment for this service may be made only in those cases in which the physician determines that obesity is exogenous in nature, the recipient has had the benefit of other therapy with no success, endocrine disorders have been ruled out, and the body mass index (BMI) is 40 or higher, or 35 to 39.9 with serious medical complications.

The medical record must contain the following documentation of medical necessity:
 

  • Documentation of review of systems (history and physical);
  • Client height, weight and BMI;
  • Listing of co-morbidities;
  • Patient weight loss attempts;
  • Current and complete psychiatric evaluation indicating the patient is an appropriate candidate for weight loss surgery;

Documentation of nutritional counseling.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.
 

Theresa A. Eagleson, Administrator
Division of Medical Programs