047 Preauthorization Request Form for Surgical Management of Obesity 2025

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The document is a Preauthorization Request Form for gastric bypass surgery under the Surgical Management of Obesity Policy by Blue Cross Blue Shield of Massachusetts. It outlines the necessary patient information, physician details, procedure codes, and medical necessity criteria for approving surgical treatment for obesity. The form requires documentation of the patient's BMI, co-morbidities, and previous weight loss attempts to determine eligibility for surgery.

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What is the CPT code for obesity surgery?

Gastric bypass and other types of weight-loss surgery also called bariatric or metabolic surgery involve making changes to your digestive system to help you lose weight. Bariatric surgery is done when diet and exercise havent worked or when you have serious health problems because of your weight.

How do I get my insurance to approve weight-loss surgery?

Common requirements are: Over age 18 (Some plans allow for surgery under age 18) BMI over 40 or BMI over 35 with high blood pressure, type 2 diabetes, or other risk factors. Documented weight loss efforts over a period of time. Weight loss program mandated by the insurance company. Psychological testing.

What do I say to get approved for weight-loss surgery?

Talk to your doctor about your weight loss goals: Discuss your weight loss goals with your doctor and explain why you believe surgery is the best option for you. Be sure to provide any relevant medical information, such as previous weight loss attempts or obesity-related health conditions.

Is it hard to get approved for weight-loss surgery?

Medical guidelines The surgery may also be an option for an adult who meets these three conditions: BMI of 35 or higher. At least one obesity-related medical condition. At least six months of supervised weight-loss attempts.

How to get approved for weight loss surgery?

Bariatric Surgery Procedures CPT Code range 43770- 43775. The Current Procedural Terminology (CPT) code range for Bariatric Surgery Procedures 43770-43775 is a medical code set maintained by the American Medical Association.